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

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Persistent cognitive impairment after critical illness is a growing concern. Modifiable factors during ICU stays, like hypotension and hypoxemia, are linked to this condition, offering potential prevention strategies.

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Area of Science:

  • Critical care medicine
  • Neuroscience
  • Public health

Background:

  • Persistent cognitive impairment following critical illness is a significant and escalating healthcare challenge.
  • The epidemiology and risk factors for post-intensive care unit (ICU) cognitive impairment require further exploration.
  • Identifying modifiable risk factors during ICU hospitalization is crucial for developing preventive interventions.

Purpose of the Study:

  • To determine potentially modifiable risk factors during ICU hospitalization that contribute to the development of persistent cognitive impairment.
  • To investigate the epidemiology of new and persistent cognitive impairment after ICU discharge.

Main Methods:

  • An observational case-control study was conducted within Mayo Clinic ICUs from July 2004 to November 2015.
  • A large cohort of 98,227 adult critically ill patients was analyzed using validated computable phenotypes for cognitive impairment.
  • New and persistent cognitive impairment was assessed between 3 and 24 months post-ICU discharge, with analyses adjusted for baseline differences.

Main Results:

  • 2.5% of ICU patients (2,428 out of 21,923 identified as cognitively impaired) developed new and persistent cognitive dysfunction post-ICU admission.
  • Cases with cognitive dysfunction had higher comorbidity burden and more frequent ICU stays compared to controls.
  • Adjusted analyses revealed associations between cognitive dysfunction and acute brain failure, severe hypotension, hypoxemia, hyperthermia, glucose fluctuations, and specific antibiotic use (quinolones, vancomycin).

Conclusions:

  • Cognitive dysfunction is prevalent in ICU patients, with new and persistent impairment being a less common but significant issue.
  • Chronic comorbidities and multiple ICU stays are independent risk factors for post-ICU cognitive dysfunction.
  • Identified modifiable ICU exposures present potential targets for future prevention trials to mitigate cognitive impairment after critical illness.