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


METHODS
Prospective cohort study.


METHODS
Dutch medical-surgical ICU.


METHODS
One-year ICU survivors, admitted to the ICU ≥48 hours.


METHODS
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).


CONCLUSIONS
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.
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Annemiek E
AE
Wolters
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.|Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Linda M
LM
Peelen
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.|Institute of Psychology, Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
Dieuwke S
DS
Veldhuijzen
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Irene J
IJ
Zaal
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Dylan W
DW
de Lange
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Wietze
W
Pasma
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Diederik
D
van Dijk
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Olaf L
OL
Cremer
Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Arjen J C
AJC
Slooter
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology*; D003693:Delirium / Q000150:complications*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D013997:Time Factors
D002097:C-Reactive Protein
C-reactive protein; delirium; intensive care unit; long-term self-reported cognitive problems; systemic inflammation