Abstract
BackgroundMany intensive care unit (ICU) survivors develop psychological problems and cognitive impairment. The relation between sepsis, delirium, and later cognitive problems is not fully elucidated, and the impact of psychological symptoms on cognitive function is poorly studied in ICU survivors. The primary aim of this study was to examine the relationship between sepsis, ICU delirium, and later self-rated cognitive function. A second aim was to investigate the association between psychological problems and self-rated cognitive function 3 months after the ICU stay.MethodsPatients staying more than 24 h at the general ICU at the Karolinska University Hospital Solna, Stockholm, Sweden, were screened for delirium with the Confusion Assessment Method-ICU (CAM-ICU) during their ICU stay. Sepsis incidence and severity were recorded. Three months later, 216 patients received the Cognitive Failures Questionnaire (CFQ), Hospital Anxiety and Depression Scale (HADS), and Post-Traumatic Stress Symptoms-10 (PTSS-10) questionnaires via postal mail.ResultsOne hundred twenty-five patients (60%) responded to all questionnaires. Among respondents, the incidence of severe sepsis or septic shock was 42%. The overall incidence of delirium was 34%. Patients with severe sepsis/septic shock had a higher incidence of delirium, with an odds ratio (OR) of 3.7 (95% confidence interval (CI), 1.7–8.1). Self-rated cognitive problems 3 months post-ICU were found in 58% of the patients. We did not find any association between sepsis or delirium and late self-rated cognitive function. However, there was a correlation between psychological symptoms and self-rated cognitive function, with the strongest correlation between PTSS-10 scores and CFQ scores (r = 0.53; p < 0.001).ConclusionsICU delirium is more common in severely septic/septic shock patients. In our cohort, neither severe sepsis nor ICU delirium was associated with self-rated cognitive function 3 months after the ICU stay. Ongoing psychological symptoms, particularly post-traumatic stress was associated with worse self-rated cognitive function. Psychological symptoms need to be taken into account when assessing cognitive function in ICU survivors.
Highlights
Many intensive care unit (ICU) survivors develop psychological problems and cognitive impairment
The overall incidence of ICU delirium was 34%, with a significantly higher incidence in patients with severe sepsis/septic shock (Fig. 2), with a crude odds ratio (OR) of 3.7, and with an adjusted OR of 2.9
Neither severe sepsis/septic shock nor ICU delirium was associated with self-rated cognitive function 3 months after the ICU stay
Summary
Many intensive care unit (ICU) survivors develop psychological problems and cognitive impairment. A second aim was to investigate the association between psychological problems and self-rated cognitive function 3 months after the ICU stay. A significant proportion of ICU survivors develops multiple complications, including cognitive impairment and psychological problems. The incidence and duration of delirium have been associated with prolonged hospitalization and increased mortality and morbidity [7,8,9] and been indicated as a risk factor for the development of later cognitive problems weeks to months after the ICU stay [10,11,12]. Besides carrying a high mortality rate, sepsis is associated with a significant burden of morbidities, such as multiple organ failure [15], critical illness myopathy, and acute delirium [16]. The association between sepsis, ICU delirium, and prolonged cognitive problems is not fully elucidated, and mechanisms between postulated links are not well understood
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