Pohl Robert, Wolff Doreen, Özkan Ebru, Sprenger Antonia A, Hasenpusch Claudia, Wesenberg Judith, Düzel Emrah, Apfelbacher Christian
Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Crit Care. 2025 Apr 23;29(1):164. doi: 10.1186/s13054-025-05375-x.
The aim of this systematic review and meta-analysis is to synthesize and appraise the evidence on prevalence of cognitive impairment following acute respiratory distress syndrome (ARDS) of any cause.
We systematically searched PubMed, Scopus, and Web of Science for observational studies focused on cognitive impairment in adult survivors of ARDS. Risk of bias and certainty of evidence (GRADE) were assessed. A meta-analysis using a random effects model was performed to estimate the overall prevalence of cognitive impairment after ARDS, with subgroup analyses for COVID-19-related ARDS (C-ARDS). Additionally, a meta-regression was conducted to assess the influence of demographic and clinical predictors on cognitive outcomes. Heterogeneity was assessed using τ and the I statistic.
We identified 14 studies with 1451 participants, with 650 participants (range: 13-98) included in the analyses. In the subgroup of C-ARDS, 12 studies with 563 participants (range: 13-98) were considered. The pooled prevalence of cognitive impairment following ARDS was 36% (95% CI 26-46%), with high heterogeneity between studies (I = 92%, τ = 0.03). In C-ARDS cohorts, the prevalence was 34% (95% CI 22-45%), with similar levels of heterogeneity (I = 92.7%, τ = 0.03). Meta-regression analysis showed that older age predicted a higher prevalence of cognitive impairment following ARDS (b = 0.02, p = 0.033), reducing between-study heterogeneity (I² = 60.04%, τ² = 0.01). ICU stay, sex, and time from ICU discharge to cognitive assessment showed no significant associations (p > 0.05).
This meta-analysis corroborates previous findings that cognitive impairment remains a persistent issue for ARDS survivors. The prevalence of cognitive impairments following ARDS highlights the importance of future research to unravel the complex underlying mechanisms contributing to these deficits and to develop targeted strategies for prevention and rehabilitation in survivors.
本系统评价和荟萃分析旨在综合和评估任何原因引起的急性呼吸窘迫综合征（ARDS）后认知障碍患病率的证据。
我们系统检索了PubMed、Scopus和Web of Science，以查找关注ARDS成年幸存者认知障碍的观察性研究。评估偏倚风险和证据确定性（GRADE）。采用随机效应模型进行荟萃分析，以估计ARDS后认知障碍的总体患病率，并对COVID-19相关ARDS（C-ARDS）进行亚组分析。此外，进行荟萃回归以评估人口统计学和临床预测因素对认知结果的影响。使用τ和I统计量评估异质性。
我们确定了14项研究，共1451名参与者，其中650名参与者（范围：13 - 98）纳入分析。在C-ARDS亚组中，考虑了12项研究，共563名参与者（范围：13 - 98）。ARDS后认知障碍的合并患病率为36%（95%CI 26 - 46%），研究间异质性较高（I = 92%，τ = 0.03）。在C-ARDS队列中，患病率为34%（95%CI 22 - 45%），异质性水平相似（I = 92.7%，τ = 0.03）。荟萃回归分析表明，年龄较大预示ARDS后认知障碍患病率较高（b = 0.02，p = 0.033），降低了研究间异质性（I² = 60.04%，τ² = 0.01）。ICU住院时间、性别以及从ICU出院到认知评估的时间均无显著关联（p > 0.05）。
这项荟萃分析证实了先前的研究结果，即认知障碍仍然是ARDS幸存者的一个持续问题。ARDS后认知障碍的患病率凸显了未来研究的重要性，即揭示导致这些缺陷的复杂潜在机制，并为幸存者制定有针对性的预防和康复策略。
