Ho Mu-Hsing, Lee Yi-Wei, Wang Lizhen
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, 3 Sassoon Road, Academic Building, Pokfulam, Hong Kong.
Sijhih Cathay General Hospital, New Taipei City, Taiwan.
Ann Intensive Care. 2025 Jan 10;15(1):3. doi: 10.1186/s13613-025-01429-z.
Evidence of the overall estimated prevalence of post-intensive care cognitive impairment among critically ill survivors discharged from intensive care units at short-term and long-term follow-ups is lacking. This study aimed to estimate the prevalence of the post-intensive care cognitive impairment at time to < 1 month, 1 to 3 month(s), 4 to 6 months, 7-12 months, and > 12 months discharged from intensive care units.
Electronic databases including PubMed, Cochrane Library, EMBASE, CINAHL Plus, Web of Science, and PsycINFO via ProQuest were searched from inception through July 2024. Studies that reported on cognitive impairment among patients discharged from intensive care units with valid measures were included. Data extraction and risk of bias assessment were performed independently for all included studies according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Newcastle-Ottawa Scale was used to measure risk of bias. Data on cognitive impairment prevalence were pooled using a random-effects model. The primary outcome was pooled estimated proportions of prevalence of the post-intensive care cognitive impairment.
In total, 58 studies involving 347,940 patients were included. The pooled post-intensive care cognitive impairment prevalence rates at the follow-up timepoints < 1 month, 1-3 month(s), 4-6 months, 7-12 months, > 12 months were 49.8% [95% Prediction Interval (PI), 39.9%-59.7%, n = 19], 45.1% (95% PI, 34.8%-55.5%, n = 23), 47.9% (95% PI, 35.9%-60.0%, n = 16), 28.3% (95% PI, 19.9%-37.6%, n = 19), and 30.4% (95% PI, 18.4%-43.9%, n = 7), respectively. Subgroup analysis showed that significant differences of the prevalence rates between continents and study designs were observed.
The prevalence rates of post-intensive care cognitive impairment differed at different follow-up timepoints. The rates were highest within the first three months of follow-up, with a pooled prevalence of 49.8% at less than one month, 45.1% at one to three months, and 47.9% at three to six months. No significant differences in prevalence rates between studies that only included coronavirus disease 2019 survivors. These fundings highlight the need for further research to develop targeted interventions to prevent or manage cognitive impairment at short-term and long-term follow-ups.
缺乏关于重症监护病房出院的危重症幸存者在短期和长期随访中重症监护后认知障碍总体估计患病率的证据。本研究旨在估计重症监护病房出院后<1个月、1至3个月、4至6个月、7至12个月及>12个月时重症监护后认知障碍的患病率。
通过ProQuest检索包括PubMed、Cochrane图书馆、EMBASE、CINAHL Plus、科学引文索引和PsycINFO在内的电子数据库，检索时间从建库至2024年7月。纳入报告了重症监护病房出院患者认知障碍且测量方法有效的研究。根据系统评价和Meta分析的首选报告项目报告指南，对所有纳入研究独立进行数据提取和偏倚风险评估。使用纽卡斯尔-渥太华量表测量偏倚风险。使用随机效应模型汇总认知障碍患病率数据。主要结局是重症监护后认知障碍患病率的汇总估计比例。
共纳入58项研究，涉及347,940名患者。随访时间点<1个月、1至3个月、4至6个月、7至12个月、>12个月时重症监护后认知障碍的汇总患病率分别为49.8%[95%预测区间（PI），39.9%-59.7%，n = 19]、45.1%（95% PI，34.8%-55.5%，n = 23）、47.9%（95% PI，35.9%-60.0%，n = 16）、28.3%（95% PI，19.9%-37.6%，n = 19）和30.4%（95% PI，18.4%-43.9%，n = 7）。亚组分析显示，各大洲和研究设计之间的患病率存在显著差异。
重症监护后认知障碍的患病率在不同随访时间点有所不同。随访的前三个月患病率最高，<1个月时汇总患病率为49.8%，1至3个月时为45.1%，3至6个月时为47.9%。仅纳入2019冠状病毒病幸存者的研究之间患病率无显著差异。这些结果强调需要进一步研究，以制定有针对性的干预措施，在短期和长期随访中预防或管理认知障碍。
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