Amra Sakusic1, Ognjen Gajic1,2, Tarun D Singh1,3, John C O'Horo1,4, Gregory Jenkins5, Gregory A Wilson1, Ronald Petersen3, John D Fryer6, Rahul Kashyap1,7, Alejandro A Rabinstein3. 1. Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Mayo Clinic, Rochester, MN. 2. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 3. Department of Neurology, Mayo Clinic, Rochester, MN. 4. Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN. 5. Department of Health Sciences Research, Mayo Clinic, Rochester, MN. 6. Department of Neuroscience, Mayo Clinic, FL. 7. Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Abstract
OBJECTIVES: Persistent cognitive impairment after critical illness is an important healthcare problem forecasted to worsen in the near future. However, the epidemiology is insufficiently explored. We aimed to determine potentially modifiable risk factors during ICU hospitalization that play a significant role in developing persistent cognitive impairment. DESIGN: An observational case-control study. SETTINGS: Mayo Clinic ICUs between July 1, 2004, and November 20, 2015. PATIENTS: We conducted a study nested in a large cohort of 98,227 adult critically ill patients. Using previously validated computable phenotypes for dementia and cognitive impairment, we determined the onset of cognitive impairment relative to ICU hospitalization and associated risk factors. The primary endpoint of the study was new and persistent cognitive impairment documented between 3 and 24 months after ICU discharge. INTERVENTIONS: Unadjusted and adjusted analyses were performed to identify potentially modifiable risk factors during ICU hospitalization. MEASUREMENTS AND MAIN RESULTS: Among 21,923 unique patients identified as cognitively impaired (22% of the entire ICU cohort), 2,428 (2.5%) developed incident new and persistent cognitive dysfunction after the index ICU admission. Compared with age- and sex-matched ICU controls (2,401 pairs), cases had higher chronic illness burden (Charlson Comorbidity Index, 6.2 vs 5.1; p < 0.01), and were more likely to have multiple ICU stays (22% vs 14%; p < 0.01). After adjustment for baseline differences, new and persistent cognitive dysfunction was associated with higher frequency of acute brain failure in the ICU, a higher exposure to severe hypotension, hypoxemia, hyperthermia, fluctuations in serum glucose, and treatment with quinolones or vancomycin. Association with sepsis observed in univariate analysis did not persist after adjustment. CONCLUSIONS: Cognitive dysfunction is highly prevalent in ICU patients. Incident new and persistent cognitive impairment is less common but important, potentially preventable problem after critical illness. Chronic comorbidities and number of ICU stays increase the risk of post-ICU cognitive dysfunction irrespective of age. Modifiable ICU exposures were identified as potential targets for future prevention trials.
OBJECTIVES: Persistent cognitive impairment after critical illness is an important healthcare problem forecasted to worsen in the near future. However, the epidemiology is insufficiently explored. We aimed to determine potentially modifiable risk factors during ICU hospitalization that play a significant role in developing persistent cognitive impairment. DESIGN: An observational case-control study. SETTINGS: Mayo Clinic ICUs between July 1, 2004, and November 20, 2015. PATIENTS: We conducted a study nested in a large cohort of 98,227 adult critically ill patients. Using previously validated computable phenotypes for dementia and cognitive impairment, we determined the onset of cognitive impairment relative to ICU hospitalization and associated risk factors. The primary endpoint of the study was new and persistent cognitive impairment documented between 3 and 24 months after ICU discharge. INTERVENTIONS: Unadjusted and adjusted analyses were performed to identify potentially modifiable risk factors during ICU hospitalization. MEASUREMENTS AND MAIN RESULTS: Among 21,923 unique patients identified as cognitively impaired (22% of the entire ICU cohort), 2,428 (2.5%) developed incident new and persistent cognitive dysfunction after the index ICU admission. Compared with age- and sex-matched ICU controls (2,401 pairs), cases had higher chronic illness burden (Charlson Comorbidity Index, 6.2 vs 5.1; p < 0.01), and were more likely to have multiple ICU stays (22% vs 14%; p < 0.01). After adjustment for baseline differences, new and persistent cognitive dysfunction was associated with higher frequency of acute brain failure in the ICU, a higher exposure to severe hypotension, hypoxemia, hyperthermia, fluctuations in serum glucose, and treatment with quinolones or vancomycin. Association with sepsis observed in univariate analysis did not persist after adjustment. CONCLUSIONS:Cognitive dysfunction is highly prevalent in ICU patients. Incident new and persistent cognitive impairment is less common but important, potentially preventable problem after critical illness. Chronic comorbidities and number of ICU stays increase the risk of post-ICU cognitive dysfunction irrespective of age. Modifiable ICU exposures were identified as potential targets for future prevention trials.
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Authors: Chunxue Bai; Sanjay H Chotirmall; Jordi Rello; George A Alba; Leo C Ginns; Jerry A Krishnan; Robert Rogers; Elisabeth Bendstrup; Pierre-Regis Burgel; James D Chalmers; Abigail Chua; Kristina A Crothers; Abhijit Duggal; Yeon Wook Kim; John G Laffey; Carlos M Luna; Michael S Niederman; Ganesh Raghu; Julio A Ramirez; Jordi Riera; Oriol Roca; Maximiliano Tamae-Kakazu; Antoni Torres; Richard R Watkins; Miriam Barrecheguren; Mirko Belliato; Hassan A Chami; Rongchang Chen; Gustavo A Cortes-Puentes; Charles Delacruz; Margaret M Hayes; Leo M A Heunks; Steven R Holets; Catherine L Hough; Sugeet Jagpal; Kyeongman Jeon; Takeshi Johkoh; May M Lee; Janice Liebler; Gerry N McElvaney; Ari Moskowitz; Richard A Oeckler; Iñigo Ojanguren; Anthony O'Regan; Mathias W Pletz; Chin Kook Rhee; Marcus J Schultz; Enrico Storti; Charlie Strange; Carey C Thomson; Francesca J Torriani; Xun Wang; Wim Wuyts; Tao Xu; Dawei Yang; Ziqiang Zhang; Kevin C Wilson Journal: Eur Respir Rev Date: 2020-10-05