Cognitive recovery of post critical care patients with and without COVID-19: differences and similarities, an observational study.

Anna Gorsler, Christiana Franke, Anneke Quitschau, Nadine Külzow
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Abstract

Background: Coronavirus disease (COVID-19) patients treated in an intensive care unit (ICU) are at high risk of developing cognitive impairments of a "post-intensive care syndrome" (PICS). We explored whether critically ill COVID-19 and non-COVID-19 survivors differ in their post-ICU recovery course in terms of severity and affected cognitive domains.

Methods: An observational prospective study was conducted in a German post-acute neurological early rehabilitation clinic. Critically ill patients with or without SARS-CoV-2 infection (at least mechanically ventilated for one week) underwent repeated standardized assessments during their subsequent inpatient rehabilitation stay. Cognitive functions (information processing speed, learning, recognition, short-term and working-memory, word fluency, flexibility) assigned to different domains (attention, memory, executive functions) were assessed as primary outcome. Secondary outcomes included mental (depression, anxiety) and physical (Barthel index, modified ranking scale) state.

Results: Out of 92 eligible patients (screened between June 2021 and August 2023), 34 were examined, and 30 were available for analysis (15 per group). Both groups were ventilated for a similar period (COVID-19 vs. Non-COVID-19: median: 48 vs. 53 days). Patients of COVID-19 group spend on average 10 days longer at ICU and developed slightly more complications, but subsequent inpatient rehabilitation was of comparable duration (median: 36.5 vs. 37 days). On the group-level both groups showed similar cognitive dysfunctions with striking impairments (normative T-scores < 41) in information processing speed, word fluency, flexibility, and recognition memory on admission. Significant gains until discharge were only revealed for information processing speed in both groups (main effect visit, mean difference [95%CI] - 7.5 [- 13.1, - 2.0]). Physical and mental state were also similarly affected in both groups on admission, but improved over time, indicating that overall recovery for higher-order cognitive functions is slowest. Interestingly, majority of patients stated correctly being still physically disabled, while a discrepancy was found between subjective and objective evaluation of cognitive health.

Conclusions: Results suggest a substantial overlap of cognitive, mental and physical dysfunction in post-acute recovery of ICU survivors independent of SARS-CoV-2 infection which warrants further monitoring to reduce the risk of long-term burden and enable a return to previous functionality.

Trial registration: Retrospectively registered at https://drks.de/search/de/trial/DRKS00025523 , 21.06.2021.

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一项观察性研究:有 COVID-19 和没有 COVID-19 的重症监护后患者的认知恢复:异同。
背景:在重症监护室(ICU)接受治疗的冠状病毒病(COVID-19)患者极有可能出现 "重症监护后综合征"(PICS)的认知障碍。我们探讨了 COVID-19 重症患者和非 COVID-19 重症患者在重症监护室后的恢复过程中在严重程度和受影响的认知领域方面是否存在差异:一项前瞻性观察研究在德国一家急性期后神经系统早期康复诊所进行。感染或未感染 SARS-CoV-2 的重症患者(至少机械通气一周)在随后的住院康复期间接受了重复的标准化评估。认知功能(信息处理速度、学习能力、识别能力、短期记忆和工作记忆、文字流畅性、灵活性)被分配到不同的领域(注意力、记忆力、执行功能),作为主要结果进行评估。次要结果包括精神(抑郁、焦虑)和身体(巴特尔指数、改良等级量表)状态:在 92 名符合条件的患者(筛选时间为 2021 年 6 月至 2023 年 8 月)中,34 人接受了检查,30 人可用于分析(每组 15 人)。两组患者的通气时间相近(COVID-19 组与非 COVID-19 组:中位数:48 天与 53 天)。COVID-19 组患者在重症监护室的平均住院时间长 10 天,并发症略多,但随后的住院康复时间相当(中位数:36.5 天对 37 天)。在组别层面上,两组患者的认知功能障碍相似,都有显著的损伤(常模 T-评分结论):结果表明,ICU 幸存者在急性恢复期后的认知、精神和身体功能障碍有很大的重叠,与 SARS-CoV-2 感染无关,值得进一步监测,以降低长期负担的风险,并使其恢复到以前的功能:回顾性注册:https://drks.de/search/de/trial/DRKS00025523 , 21.06.2021。
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