Neurocognitive and Quality-of-Life Outcomes Following Intensive Care Admission: A Prospective 6-Month Follow-Up Study
Viswesvaran Balasubramanian, J. C. Suri, Debasis Behera, Pankaj Gupta, Shibdas Chakrabarti
Neurocognitive impairment, Post intensive care, Quality of life
Citation Information :
Balasubramanian V, Suri JC, Behera D, Gupta P, Chakrabarti S. Neurocognitive and Quality-of-Life Outcomes Following Intensive Care Admission: A Prospective 6-Month Follow-Up Study. Indian J Crit Care Med 2020; 24 (10):932-937.
Background: Post-intensive care survivors have decreased quality of life scores and prolonged cognitive dysfunction due to baseline factors and events related to intensive care unit admission, which remain largely unrecognized. Materials and methods: A prospective observational cohort study to assess the quality of life and occurrence of cognitive dysfunction, 3 and 6 months following discharge from the intensive care unit, was carried out. We enrolled 136 adults presenting to the intensive care unit with no prior cognitive dysfunction or depression and followed up and assessed them with repeatable battery for the assessment of neuropsychological status (RBANS) and quality of life with short Form-36 (SF-36) health survey. Results: The incidence and prevalence of cognitive dysfunction was 100% at 3 and 6 months, respectively, as assessed by RBANS with a global cognition scores at 3 and 6 months of 71 (IQR 68.5–73) and 74 (IQR 72–86), respectively. Higher Charlson's comorbidity score, increased severity of illness, longer duration of mechanical ventilation, pain, delirium, coma, and hospital stay were associated with statistically significant lower scores at 3 months. The median SF-36 mental component score (MCS) and physical component score (PCS) at 3 months were 38.4 and 32.5 and at 6 months were 38.2 and 32.6, respectively. Poor score was associated significantly with advancing age, poor functional parameters at baseline as evidenced by clinical frailty, poor baseline Katz ADL scores, increased severity of illness, longer duration of mechanical ventilation, occurrence and duration of delirium, coma, pain, and usage of sedatives with or without analgesics. Conclusion and clinical significance: Patients discharged from the intensive care unit are at high risk for persistent cognitive impairment and poor quality of life score. Poor baseline patient characteristics and events occurring in ICU are associated with worse cognition and quality of life scores. There is an urgent need to prevent, diagnose, and manage these patients by optimizing intensive care practices.
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