From the Critical Illness, Brain Dysfunction and Survivorship Center, Center for Health Services Research (M.F.N., M.B.P., C.R.E., A.K., J.C.J., P.P.P., E.W.E., J.E.W.), Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, (M.F.N., M.B.P.), Department of Hearing and Speech Sciences (M.B.P), Department of Neurosurgery (M.B.P) Department of Psychiatry (J.E.W.), Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine (J.C.J., E.W.E.), Division of Anesthesiology Critical Care, Department of Anesthesiology (P.P.P.), and Department of Biostatistics (R.R.), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research Education and Clinical Center (M.B.P., J.C.J., P.P.P., E.W.E., J.E.W.), Tennessee Valley Healthcare System, Nashville TN; and Vanderbilt University School of Medicine (M.B.P., C.R.E., P.P.P., E.W.E., J.E.W.).
J Trauma Acute Care Surg. 2021 Jan 1;90(1):79-86. doi: 10.1097/TA.0000000000002955.
Intensive care unit (ICU) survivorship is associated with long-term cognitive impairment (LTCI). Our work has found post-ICU depression in up to 30% and posttraumatic stress disorder (PTSD) in up to 10% of ICU survivors. We hypothesized that post-ICU depression and PTSD are independently associated with LTCI in ICU survivors.
This is a five-center nested prospective cohort of critically ill patients admitted to medical and surgical ICUs who underwent neuropsychological assessments at 3 and 12 months posthospital discharge. Our primary outcome was global cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail Making Test, Part B, a test of executive functioning, at 3- and 12-month follow-up. Our independent variables were Beck Depression Inventory II and the PTSD Checklist-Specific Version measured at 3 and 12 months. We performed multivariable linear regression models controlling for covariates such as age, years of education, preexisting cognitive impairment, comorbidities, ventilator days, hypoxemia episodes, and days of delirium or coma.
Of 1,047 patients in the combined cohort, 679 were alive and available for follow-up at 3 months. A total of 590 (87%) ICU survivors completed at least one 3-month assessment, and of the 554 who survived to 12 months, 519 (94%) completed both a 3- and 12-month assessment with a median age of 61 years (52-70 years) and mean daily Sequential Organ Failure Assessment score of 6 (4-8), 520 (88%) were mechanically ventilated, and 420 (71%) were with delirium. Of these, 113 (19%) had PTSD and 187 (32%) had depression at 3 months with similar rates at 12 months. Depression at 3 months was associated with lower 3-month RBANS (coefficient, -2.25; -3.10 to -1.39) and lower Trails B scores at both 3 months (odds ratio, 0.69; 0.56-0.85) and 12 months (odds ratio, 0.66; 0.52-0.84). Posttraumatic stress disorder at 3 months had no association with RBANS or Trails B scores at 3 or 12 months.
Early post-ICU depression, but not PTSD, is independently associated with coexisting LTCI, even when controlling for past ICU delirium. Treatment for early depression represents a novel intervention area for LTCI prevention in ICU survivors.
Prognostic/epidemiological, level III.
重症监护病房（ICU）的存活与长期认知障碍（LTCI）有关。我们的研究发现，多达 30%的 ICU 幸存者会出现 ICU 后抑郁，多达 10%的 ICU 幸存者会出现创伤后应激障碍（PTSD）。我们假设 ICU 后抑郁和 PTSD 与 ICU 幸存者的 LTCI 独立相关。
这是一项五个中心嵌套的前瞻性队列研究，纳入了入住内科和外科 ICU 的危重病患者，他们在出院后 3 个月和 12 个月接受神经心理评估。我们的主要结局是使用重复性成套神经心理状态测试（RBANS）和 3 个月和 12 个月时的执行功能测试 Trail Making Test，Part B 来评估整体认知功能。我们的自变量是在 3 个月和 12 个月时测量的贝克抑郁量表 II 和 PTSD 检查表特异性版本。我们进行了多变量线性回归模型，控制了年龄、受教育年限、既往认知障碍、合并症、通气天数、低氧血症发作次数、谵妄或昏迷天数等混杂因素。
在合并队列的 1047 名患者中，有 679 名患者存活并可在 3 个月时进行随访。共有 679 名（87%）ICU 幸存者完成了至少一次 3 个月的评估，在 554 名存活至 12 个月的幸存者中，有 519 名（94%）完成了 3 个月和 12 个月的评估，中位年龄为 61 岁（52-70 岁），每日序贯器官衰竭评估评分的平均值为 6（4-8），520 名（88%）患者接受机械通气，420 名（71%）患者发生谵妄。其中，113 名（19%）患者在 3 个月时患有 PTSD，187 名（32%）患者在 3 个月时患有抑郁，12 个月时的比例相似。3 个月时的抑郁与 3 个月时的 RBANS 评分较低（系数，-2.25；-3.10 至-1.39）和 Trail B 评分较低有关，在 3 个月（比值比，0.69；0.56-0.85）和 12 个月（比值比，0.66；0.52-0.84）时均如此。3 个月时的创伤后应激障碍与 3 个月或 12 个月时的 RBANS 或 Trail B 评分无关联。
早期 ICU 后抑郁，而不是 PTSD，与并存的 LTCI 独立相关，即使在控制过去 ICU 谵妄的情况下也是如此。早期抑郁的治疗代表了 ICU 幸存者预防 LTCI 的一个新的干预领域。
预后/流行病学，III 级。
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