Jesus Pereira Isabel, Santos Mariana, Sganzerla Daniel, Robinson Caroline Cabral, de Souza Denise, Kochhann Renata, Falavigna Maicon, Azevedo Luis, Bozza Fernando, Sharshar Tarek, Goulart Rosa Regis, Granja Cristina, Teixeira Cassiano
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
SIM-FMUP-Simulation Center, Faculty of Medicine, University of Porto, Porto, Portugal.
Ann Intensive Care. 2024 Jul 29;14(1):116. doi: 10.1186/s13613-024-01335-w.
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.
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.
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).
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.
确定成年患者重症监护病房（ICU）出院1年后认知功能障碍的患病率及相关因素，以及其与生活质量的关系。
多中心前瞻性队列研究，纳入2014年5月至2018年12月期间巴西10家三级医院的ICU。纳入患者为452名成年ICU幸存者（中位年龄60岁；47.6%为女性），ICU住院时间超过72小时。
在ICU出院12个月时，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个月时，在完成认知评估的452名ICU幸存者中，216名（47.8%）存在认知功能障碍。在多变量分析中，与长期（1年）认知功能障碍相关的因素包括年龄较大（患病率比值比-PR = 1.44，P < 0.001）、未接受高等教育（PR = 2.81，P = 0.005）、入院时合并症较多（PR = 1.089；P = 0.004）和谵妄（PR = 1.13，P < 0.001）。通过SF-12v2的心理和生理维度评估的健康相关生活质量（HRQoL），在无认知功能障碍的患者中显著更好（心理SF-12v2平均差异 = 2.54；95%置信区间，-4.80/-0.28；p = 0.028，生理SF-12v2平均差异 = -2.85；95%置信区间，-5.20/-0.50；P = 0.018）。
谵妄被发现是ICU幸存者长期认知功能障碍的主要可改变预测因素。高等教育持续降低长期认知功能障碍的发生概率。认知功能障碍显著影响患者的生活质量，这使我们强调认知储备对ICU出院后长期预后的重要性。
