Long term cognitive dysfunction among critical care survivors: associated factors and quality of life-a multicenter cohort study.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Isabel Jesus Pereira, Mariana Santos, Daniel Sganzerla, Caroline Cabral Robinson, Denise de Souza, Renata Kochhann, Maicon Falavigna, Luis Azevedo, Fernando Bozza, Tarek Sharshar, Regis Goulart Rosa, Cristina Granja, Cassiano Teixeira
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Abstract

Objectives: To identify the prevalence and associated factors of cognitive dysfunction, 1 year after ICU discharge, among adult patients, and it´s relation with quality of life.

Methods: Multicenter, prospective cohort study including ICUs of 10 tertiary hospitals in Brazil, between May 2014 and December 2018. The patients included were 452 adult ICU survivors (median age 60; 47.6% women) with an ICU stay greater than 72 h.

Results: At 12 months after ICU discharge, a Montreal Cognitive Assessment (tMOCA) telephone score of less than 12 was defined as cognitive dysfunction. At 12 months, of the 452 ICU survivors who completed the cognitive evaluation 216 (47.8%) had cognitive dysfunction. In multivariable analyses, the factors associated with long-term (1-year) cognitive dysfunction were older age (Prevalence Ratio-PR = 1.44, P < 0.001), absence of higher education (PR = 2.81, P = 0.005), higher comorbidities on admission (PR = 1.089; P = 0.004) and delirium (PR = 1.13, P < 0.001). Health-related Quality of life (HRQoL), assessed by the mental and physical dimensions of the SF-12v2, was significantly better in patients without cognitive dysfunction (Mental SF-12v2 Mean difference = 2.54; CI 95%, - 4.80/- 0.28; p = 0.028 and Physical SF-12v2 Mean difference = - 2.85; CI 95%, - 5.20/- 0.50; P = 0.018).

Conclusions: Delirium was found to be the main modifiable predictor of long-term cognitive dysfunction in ICU survivors. Higher education consistently reduced the probability of having long-term cognitive dysfunction. Cognitive dysfunction significantly influenced patients' quality of life, leading us to emphasize the importance of cognitive reserve for long-term prognosis after ICU discharge.

Abstract Image

重症监护幸存者的长期认知功能障碍:相关因素与生活质量--一项多中心队列研究。
目的确定成人患者在重症监护室出院 1 年后认知功能障碍的发生率和相关因素,以及认知功能障碍与生活质量的关系:多中心、前瞻性队列研究,包括2014年5月至2018年12月期间巴西10家三级医院的重症监护室。纳入的患者为452名ICU存活的成人(中位年龄60岁;47.6%为女性),ICU住院时间超过72小时:ICU 出院后 12 个月,蒙特利尔认知评估(tMOCA)电话评分低于 12 分被定义为认知功能障碍。12 个月后,在完成认知评估的 452 名重症监护室幸存者中,有 216 人(47.8%)出现认知功能障碍。在多变量分析中,与长期(1 年)认知功能障碍相关的因素是年龄较大(Prevalence Ratio-PR = 1.44,P 结论:年龄越大,认知功能障碍越严重:研究发现,谵妄是 ICU 存活者长期认知功能障碍的主要可调节预测因素。受教育程度越高,出现长期认知功能障碍的概率越低。认知功能障碍严重影响了患者的生活质量,因此我们强调认知储备对 ICU 出院后长期预后的重要性。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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