Skip to main content

Master of Public Health

Depression Predicts Long-Term Cognitive Impairment in Survivors of Critical Illness

AUTHORS

Nordness MF , Patel MB , Erickson CR , Kiehl A , Jackson JC , Raman R , Pandharipande PP , Ely EW , Wilson JE , . The journal of trauma and acute care surgery. 2020 10 2; ().

ABSTRACT

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 Post-Traumatic Stress Disorder (PTSD) in up to 10% of Intensive Care Unit (ICU) survivors. We hypothesized that post-ICU depression and PTSD are independently associated with LTCI in ICU survivors.

METHODS: 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 post hospital discharge. Our primary outcome was global cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail Making Part B, a test of executive functioning, at 3 and 12 month follow-up. Our independent variables were Beck Depression Inventory-II (BDI-II) and the PTSD Checklist (PCL-S) measured at 3 and 12 months. We performed multivariable linear regression models controlling for covariates such as age, years of education, pre-existing cognitive impairment, comorbidities, ventilator days, hypoxemia episodes, and days of delirium or coma.

RESULTS: Of 1047 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), mean daily Sequential Organ Failure Assessment (SOFA) score of 6 (4 – 8), 520 (88%) mechanically ventilated, and 420 (71%) 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, -1.39) and lower Trails B scores at both 3- (OR 0.69; 0.56, 0.85) and 12-months (OR 0.66; 0.52, 0.84). PTSD at 3-months had no association with RBANS or Trails B scores at 3- or 12 months.

CONCLUSIONS: Early post-ICU depression, but not PTSD, is independently associated with co-existing LTCI, even when controlling for past ICU delirium. Treatment for early depression represents a novel intervention area for LTCI prevention in ICU survivors.

LEVEL OF EVIDENCE: prognostic/epidemiological, Level III.

Tags: