Abstract
BackgroundThere is growing evidence that sepsis survivors are at increased risk of developing new-onset atrial fibrillation, acute kidney injury, and neurological diseases. However, whether sepsis survivals increase the risk of dementia or cognitive impairment remains to be further explored.ObjectiveThe objective of this study was to determine whether sepsis survivals increase the risk of dementia or cognitive impairment.MethodsWe searched PubMed, Cochrane Library, Web of Science, and EMBASE databases for cohort studies or case-control studies from their inception to November 5, 2021. The quality of this study was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). The Stata software (version 15.1) was used to calculate the odds ratio (OR) of dementia or cognitive impairment in sepsis survivals. Subgroup and sensitivity analyses were performed to assess the source of heterogeneity. Funnel plots and Egger’s test were used to detect the publication bias.ResultsEight studies (i.e., seven cohort studies and one case-control study) involving 891,562 individuals were included. The quality assessment results showed that the average score of NOS was over 7, and the overall quality of the included studies was high. Pooled analyses indicated that sepsis survivals were associated with an increased risk of all-cause dementia (OR = 1.62, 95% CI = 1.23–2.15, I2 = 96.4%, p = 0.001). However, there was no obvious association between sepsis survivals and the risk of cognitive impairment (OR = 1.77, 95% CI = 0.59–5.32, I2 = 87.4%, p = 0.306). Subgroup analyses showed that severe sepsis was associated with an increased risk of dementia or cognitive impairment (OR = 1.99, 95% CI = 1.19–3.31, I2 = 75.3%, p = 0.008); such risk was higher than that of other unspecified types of sepsis (OR = 1.47, 95% CI = 1.04–2.09, I2 = 97.6%, p = 0.029).ConclusionSepsis survivals are associated with an increased risk of all-cause dementia but not with cognitive impairment. Appropriate management and prevention are essential to preserve the cognitive function of sepsis survivors and reduce the risk of dementia.
Highlights
Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection (Evans et al, 2021), which has become a leading cause of death and critical illness worldwide (Vincent et al, 2014; Fleischmann et al, 2016)
The International Classification of Diseases-9 (ICD-9) or International Classification of Diseases-10 (ICD-10) diagnostic codes were used as the diagnostic criteria for sepsis and dementia in six studies (Guerra et al, 2012; Shah et al, 2013; Mawanda et al, 2016; Chou et al, 2017; Ahlström et al, 2020; Fritze et al, 2020)
Muzambi et al (2020) showed that common bacterial infections, such as pneumonia, urinary tract infection, and cellulitis, played a role in increasing the risk of dementia. Their subgroup analysis indicated that sepsis survival was associated with a 1.39–2.60-fold higher risk of dementia than non-sepsis patients, which was higher than that observed in our study
Summary
Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection (Evans et al, 2021), which has become a leading cause of death and critical illness worldwide (Vincent et al, 2014; Fleischmann et al, 2016). It is characterized by high morbidity and mortality, and more than 30 million cases occur annually worldwide, including at least 6 million deaths (WHO, 2018). A recent meta-analysis showed an incidence of 189 cases of hospital-treated adult sepsis per 100,000 person years and a mortality rate of 26.7% (Fleischmann-Struzek et al, 2020). Whether sepsis survivals increase the risk of dementia or cognitive impairment remains to be further explored
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