Gorsler Anna, Franke Christiana, Quitschau Anneke, Külzow Nadine
Clinic for Neurological Rehabilitation, Fachklinik Für Neurologische Frührehabilitation, Kliniken Beelitz GmbH, Paracelsusring 6a, Beelitz-Heilstätten, 14547, Brandenburg, Germany.
Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
Neurol Res Pract. 2024 Oct 22;6(1):50. doi: 10.1186/s42466-024-00349-w.
Coronavirus disease (COVID-19) patients treated in an intensive care unit (ICU) are at high risk of developing cognitive impairments of a "post-intensive care syndrome" (PICS). We explored whether critically ill COVID-19 and non-COVID-19 survivors differ in their post-ICU recovery course in terms of severity and affected cognitive domains.
An observational prospective study was conducted in a German post-acute neurological early rehabilitation clinic. Critically ill patients with or without SARS-CoV-2 infection (at least mechanically ventilated for one week) underwent repeated standardized assessments during their subsequent inpatient rehabilitation stay. Cognitive functions (information processing speed, learning, recognition, short-term and working-memory, word fluency, flexibility) assigned to different domains (attention, memory, executive functions) were assessed as primary outcome. Secondary outcomes included mental (depression, anxiety) and physical (Barthel index, modified ranking scale) state.
Out of 92 eligible patients (screened between June 2021 and August 2023), 34 were examined, and 30 were available for analysis (15 per group). Both groups were ventilated for a similar period (COVID-19 vs. Non-COVID-19: median: 48 vs. 53 days). Patients of COVID-19 group spend on average 10 days longer at ICU and developed slightly more complications, but subsequent inpatient rehabilitation was of comparable duration (median: 36.5 vs. 37 days). On the group-level both groups showed similar cognitive dysfunctions with striking impairments (normative T-scores < 41) in information processing speed, word fluency, flexibility, and recognition memory on admission. Significant gains until discharge were only revealed for information processing speed in both groups (main effect visit, mean difference [95%CI] - 7.5 [- 13.1, - 2.0]). Physical and mental state were also similarly affected in both groups on admission, but improved over time, indicating that overall recovery for higher-order cognitive functions is slowest. Interestingly, majority of patients stated correctly being still physically disabled, while a discrepancy was found between subjective and objective evaluation of cognitive health.
Results suggest a substantial overlap of cognitive, mental and physical dysfunction in post-acute recovery of ICU survivors independent of SARS-CoV-2 infection which warrants further monitoring to reduce the risk of long-term burden and enable a return to previous functionality.
Retrospectively registered at https://drks.de/search/de/trial/DRKS00025523 , 21.06.2021.
在重症监护病房（ICU）接受治疗的冠状病毒病（COVID-19）患者发生“重症监护后综合征”（PICS）所致认知障碍的风险很高。我们探讨了危重症COVID-19幸存者和非COVID-19幸存者在ICU后的恢复过程中，在严重程度和受影响的认知领域方面是否存在差异。
在德国一家急性后神经早期康复诊所进行了一项观察性前瞻性研究。患有或未感染SARS-CoV-2的危重症患者（至少机械通气一周）在随后的住院康复期间接受了多次标准化评估。将分配到不同领域（注意力、记忆力、执行功能）的认知功能（信息处理速度、学习、识别、短期和工作记忆、语言流畅性、灵活性）作为主要结局进行评估。次要结局包括心理状态（抑郁、焦虑）和身体状态（Barthel指数、改良Rankin量表）。
在92名符合条件的患者（2021年6月至2023年8月筛查）中，34名接受了检查，30名可供分析（每组15名）。两组的通气时间相似（COVID-19组与非COVID-19组：中位数分别为48天和53天）。COVID-19组患者在ICU的平均停留时间长10天，并发症略多，但随后的住院康复时间相当（中位数分别为36.5天和37天）。在组水平上，两组均表现出相似的认知功能障碍，入院时信息处理速度、语言流畅性、灵活性和识别记忆方面存在明显损害（标准化T分数<41）。两组直到出院时仅在信息处理速度方面有显著改善（主要效应访视，平均差异[95%CI]-7.5[-13.1，-2.0]）。两组入院时的身心状态也受到类似影响，但随着时间推移有所改善，表明高阶认知功能的总体恢复最慢。有趣的是，大多数患者正确表示仍有身体残疾，而在认知健康的主观和客观评估之间存在差异。
结果表明，ICU幸存者急性后恢复过程中的认知、心理和身体功能障碍存在大量重叠，与SARS-CoV-2感染无关，这需要进一步监测，以降低长期负担风险并实现恢复到以前的功能状态。
于2021年6月21日在https://drks.de/search/de/trial/DRKS00025523进行回顾性注册。
