Sumida Hitoshi, Yasunaga Yuichi, Takasawa Kensei, Tanaka Aya, Ida Seiko, Saito Tadaoki, Sugiyama Seigo, Matsui Kunihiko, Nakao Koichi, Tsujita Kenichi, Tohya Yuji
Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan.
Division of Cardiology, Jinnouchi Hospital, 6-2-3, Kuhonji Chuo-ku, Kumamoto, 862-0976, Japan.
Heart Vessels. 2020 Jul;35(7):946-956. doi: 10.1007/s00380-020-01566-4. Epub 2020 Feb 12.
New/worsening cognitive and physical impairments following critical care pose significant problems. Multidisciplinary cardiac rehabilitation (CR) can improve physical function after cardiac intensive care (CIC). This observational study aimed to evaluate cognitive function in patients participating in multidisciplinary CR and to identify correlates of impaired cognitive function after CIC. We analyzed 111 consecutive patients admitted to our comprehensive care ward at least 7 days after CIC and assessed factors associated with cognitive function using the Functional Independence Measure (FIM). Patients were stratified into two groups based on the median FIM-Cognitive scores: impaired (n = 56) and preserved cognition (n = 55) groups. Multiple logistic regression analysis identified age [odds ratio (OR) 1.06; 95% confidence interval (CI) 1.00-1.13; p = 0.042], Mini-Nutrition Assessment-Short Form (MNA-SF; OR 0.73; 95% CI 0.56-0.95; p = 0.017), and FIM-Physical scores (OR: 0.94; 95% CI 0.90-0.99; p = 0.012) as significant and independent factors associated with impaired cognition. The median length of hospital stay was 28 (interquartile range: 18, 43) days. The FIM-Cognitive and FIM-Physical scores significantly increased from admission to discharge [32.0 (27.0, 35.0) vs. 34.0 (29.0, 35.0) points; p < 0.001; 67.0 (53.0, 75.0) vs. 85.0 (73.5, 89.0) points; p < 0.001, respectively]. On subgroup analysis within the impaired cognition group, increased FIM-Cognitive scores positively and significantly correlated with increased FIM-Physical scores (ρ = 0.450; p = 0.001). Multiple linear regression analysis identified atrial fibrillation (AF; β = - 0.29; p = 0.016), ln(glycated hemoglobin; HbA1c) (β = 0.29; p = 0.018), and ln(high-sensitivity C-reactive protein; hs-CRP) (β = - 0.26; p = 0.034) as significant and independent factors correlated with increased FIM-Cognitive scores. In conclusion, advanced age, low MNA-SF score, and FIM-Physical score were independent factors associated with impaired cognition in post-CIC patients. Multidisciplinary CR improved both physical and cognitive functions, and AF, HbA1c, and hs-CRP were independent factors correlated with increased FIM-Cognitive score.
危重症后出现新的/恶化的认知和身体功能障碍带来了重大问题。多学科心脏康复（CR）可改善心脏重症监护（CIC）后的身体功能。这项观察性研究旨在评估参与多学科CR患者的认知功能，并确定CIC后认知功能受损的相关因素。我们分析了111例在CIC后至少7天入住我们综合护理病房的连续患者，并使用功能独立性测量（FIM）评估与认知功能相关的因素。根据FIM-认知评分中位数将患者分为两组：受损组（n = 56）和认知保留组（n = 55）。多因素逻辑回归分析确定年龄[比值比（OR）1.06；95%置信区间（CI）1.00 - 1.13；p = 0.042]、微型营养评定简表（MNA-SF；OR 0.73；95% CI 0.56 - 0.95；p = 0.017）和FIM-身体评分（OR：0.94；95% CI 0.90 - 0.99；p = 0.012）是与认知受损相关的显著且独立的因素。中位住院时间为28（四分位间距：18，43）天。从入院到出院，FIM-认知和FIM-身体评分显著增加[32.0（27.0，35.0）对34.0（29.0，35.0）分；p < 0.001；67.0（53.0，75.0）对85.0（73.5，89.0）分；p < 0.001]。在认知受损组的亚组分析中，FIM-认知评分增加与FIM-身体评分增加呈正相关且显著相关（ρ = 0.450；p = 0.001）。多因素线性回归分析确定心房颤动（AF；β = - 0.29；p = 0.016）、糖化血红蛋白（HbA1c）的自然对数[ln（HbA1c）；β = 0.29；p = 0.018]和高敏C反应蛋白（hs-CRP）的自然对数[ln（hs-CRP）；β = - 0.26；p = 0.034]是与FIM-认知评分增加相关的显著且独立的因素。总之，高龄、低MNA-SF评分和FIM-身体评分是CIC后患者认知受损的独立因素。多学科CR改善了身体和认知功能，AF、HbA1c和hs-CRP是与FIM-认知评分增加相关的独立因素。
