Socioeconomic Factors And Intensive Care Unit (ICU) Related Cognitive Impairment
*Diane N. Haddad, *Matthew F Mart, *Li Wang, *Christopher J. Lindsell, *Rameela Chandrasekhar, *Mina F. Nordness, Kenneth W Sharp, *Pratik P. Pandharipande, *Timothy D. Girard, *E. Wesley Ely, *Mayur B. Patel
Vanderbilt, Nashville, TN
OBJECTIVE(S): After an intensive care unit (ICU) stay with delirium, long-term cognitive impairment (LTCI) has been increasingly recognized, but without attention to socioeconomic factors. We aim to identify socioeconomic factors and their impact on post-ICU LTCI .
METHODS: We enrolled a civilian and veteran affairs (VA) prospective multicenter cohort of ICU survivors with shock or respiratory failure recruited at surgical and medical ICUs across 5 hospitals from 2010 to 2016. Our primary outcome was LTCI at 3- and 12-months post-hospital discharge defined by the Repeatable Battery for the Assessment of Neuropsychological Symptoms (RBANS) global score. Covariates adjusted using multivariable linear regression included age; sex; race; scores of AHRQ socioeconomics, Charlson comorbidity, Framingham stroke risk, & Sequential Organ Failure Assessment; duration of coma, delirium, education years, hypoxemia, & sepsis; type of hospital, insurance, & discharge; and ICU drug exposures (analgosedatives, antipsychotics).
RESULTS: Of 1040 ICU patients, unadjusted analysis indicated 71% sustained delirium, and of survivors, 47% and 41% had RBANS scores below one standard deviation at 3 and 12 months, respectively. Adjusted analysis indicated that delirium, non-white race, lower education, and civilian hospitals (all p<=0.03, one-half standard deviation effect size) were associated with lower RBANS scores at 3 and 12 months. Sex, AHRQ socioeconomic score, insurance type, and discharge disposition were not clearly associated with RBANS.
CONCLUSIONS: Some socioeconomic factors, such as race, education, and hospital facility type, were linked to worse post-ICU LTCI. Further efforts may focus on improved identification of these higher risk groups, and offering post-discharge neuropsychological support.
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