This exploratory study aimed to determine the prevalence of impaired cognition one year after surviving iICU care due to severe COVID-19 and to identify the risk factors from during the care period, based on a cohort included during the first wave of the pandemic.
This multicenter cohort study, the Gothenburg Rehabilitation and Recovery After COVID-19 (GOTRECOV-19 ICU study), had a cross-sectional and a longitudinal design including individuals treated in five intensive care units (ICUs) at Sahlgrenska University Hospital, Sweden, during the first wave of the COVID-19 pandemic. The GOTRECOV-19 ICU study involves both questionnaires and clinical assessments. This sub-study involves a component of the clinical examination.
Individuals aged 18 or older who were admitted to any of the five ICUs at Sahlgrenska University Hospital/Östra between 2020-03-01 and 2020-06-30 with the diagnostic code U07.1 and were still alive one year later met the inclusion criteria. Individuals not registered as a resident of Sweden in the Swedish Population Register or not living in Gothenburg and its surrounding municipalities were excluded.
The primary outcome, cognitive impairment, was measured at a one-year follow-up following the admission to ICU using the Montreal Cognitive Assessment (MoCA). Impaired cognitive function was defined as a MoCA score of ≤25. The independent variables, including demographic data, comorbidities, and ICU complications, were retrospectively collected from the time of admission. The associations between these variables and cognitive impairment were analyzed using univariable and multivariable logistic regression analyses.
A total of 71 out of the 182 eligible individuals participated in the cognitive assessment at Sahlgrenska University Hospital. Of those, 16 (22.5%) were classified having impaired cognitive function. Using multivariable logistic analysis, having diabetes mellitus (odds ratio: 3.87, 95% confidence interval: 1.15-13.02) was a statistically significant predictor of impaired cognitive function at one year post-ICU admission following COVID-19.
Among the participants, more than every fifth was found to have impaired cognitive function one year after ICU admission due to severe COVID-19. Diabetes mellitus emerged as a predictor of cognitive impairment and the results suggests that individuals with diabates were almost four times more likely to experience cognitive impairment of year post-ICU admission compared to those without diabetes.
Suggestions for further work is to perform comparative studies across different COVID-19 waves. Future studies could focus on how vaccination affects long-term cognitive outcomes following severe COVID-19. In addition, future studies should focus on following patients for several years after intensive care which can provide insights into whether cognitive issues worsen or improve over time and whether post-COVID-19 cognitive recovery differs from recovery after other critical illnesses.
The study is small; however, it gives an initial awareness of cognitive impairment and could serve as a preliminary basis for discussions and encouragement for larger studies to reach substance of findings and their application in practice.
COGNITIVE FUNCTION
LONG-TERM FOLLOW-UP
