Risk Factors for Persistent Cognitive Impairment After Critical Illness, Nested Case-Control Study

Amra Sakusic, Ognjen Gajic, Tarun D. Singh, John C. O'Horo, Gregory Jenkins, Gregory A. Wilson, Ronald Carl Petersen, John D. Fryer, Rahul Kashyap, Alejandro Rabinstein

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1977-1984
Number of pages8
JournalCritical Care Medicine
Volume46
Issue number12
DOIs
StatePublished - Dec 1 2018

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Critical Illness
Case-Control Studies
Hospitalization
Comorbidity
Cognitive Dysfunction
Social Adjustment
Quinolones
Vancomycin
Hypotension
Dementia
Sepsis
Epidemiology
Chronic Disease
Fever
Delivery of Health Care
Phenotype
Glucose
Brain
Serum

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Risk Factors for Persistent Cognitive Impairment After Critical Illness, Nested Case-Control Study. / Sakusic, Amra; Gajic, Ognjen; Singh, Tarun D.; O'Horo, John C.; Jenkins, Gregory; Wilson, Gregory A.; Petersen, Ronald Carl; Fryer, John D.; Kashyap, Rahul; Rabinstein, Alejandro.

In: Critical Care Medicine, Vol. 46, No. 12, 01.12.2018, p. 1977-1984.

Research output: Contribution to journalArticle

Sakusic, Amra ; Gajic, Ognjen ; Singh, Tarun D. ; O'Horo, John C. ; Jenkins, Gregory ; Wilson, Gregory A. ; Petersen, Ronald Carl ; Fryer, John D. ; Kashyap, Rahul ; Rabinstein, Alejandro. / Risk Factors for Persistent Cognitive Impairment After Critical Illness, Nested Case-Control Study. In: Critical Care Medicine. 2018 ; Vol. 46, No. 12. pp. 1977-1984.
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AU - O'Horo, John C.

AU - Jenkins, Gregory

AU - Wilson, Gregory A.

AU - Petersen, Ronald Carl

AU - Fryer, John D.

AU - Kashyap, Rahul

AU - Rabinstein, Alejandro

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