Long‐Term Self‐Reported Cognitive Problems After Delirium in the Intensive Care Unit and the Effect of Systemic Inflammation

• Published in: Journal of the American Geriatrics Society (JAGS) 2017-04, Vol.65 (4), p.786-791
• Main Authors: Wolters, Annemiek E., Peelen, Linda M., Veldhuijzen, Dieuwke S., Zaal, Irene J., Lange, Dylan W., Pasma, Wietze, Dijk, Diederik, Cremer, Olaf L., Slooter, Arjen J. C.
• Format: Article
• Language: English
• Subjects: Aged; C-Reactive Protein - analysis; Cognition Disorders - epidemiology; Cognition Disorders - etiology; C‐reactive protein; Delirium; Delirium - complications; Female; Humans; Inflammation; Inflammation - complications; Intensive care; intensive care unit; Intensive Care Units; long‐term self‐reported cognitive problems; Male; Middle Aged; Netherlands - epidemiology; Prospective Studies; Risk Factors; Self Report; systemic inflammation; Time Factors
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.14660

Objectives To describe the association between intensive care unit (ICU) delirium and self‐reported cognitive problems in 1‐year ICU survivors, and investigate whether this association was altered by exposure to systemic inflammation during ICU stay. Design Prospective cohort study. Setting Dutch medical‐surgical ICU. Participants One‐year ICU survivors, admitted to the ICU ≥48 hours. Measurements Self‐reported cognitive problems were measured with the Cognitive Failures Questionnaire (CFQ). Cumulative exposure to systemic inflammation was based on all daily C‐reactive protein (CRP) measurements during ICU stay, expressed as the area under the curve (AUC). Multivariable linear regression was conducted to evaluate the association between delirium and the CFQ. The effect of inflammation on the association between delirium and CFQ was assessed, comparing the effect estimate (B) of delirium and CFQ between models with and without inclusion of the AUC of CRP. Results Among 567 1‐year ICU survivors, the CFQ was completed by 363 subjects. Subjects with multiple days of delirium during ICU stay reported more self‐reported cognitive problems (Badj = 5.10, 95% CI 1.01–9.20), whereas a single day delirium was not associated with higher CFQ scores (Badj = −0.72, 95% CI −5.75 to 4.31). Including the AUC of CRP did not change the association between delirium and the CFQ (ratio for a single and multiple days were respectively: 1.00, 95%CI 0.59–1.44 and 0.86, 95% CI 0.47–1.16). Conclusion Multiple days of delirium was associated with long‐term self‐reported cognitive problems. The cumulative exposure to systemic inflammation did not alter this association, suggesting that delirium in the context of little inflammation is also detrimental.