Biomarkers of Neuropsychiatric Dysfunction in Intensive Care Unit Survivors: a Prospective Cohort Study

Overview

Journal Crit Care Sci

Specialties Critical Care
General Medicine

Date 2023 Sep 15

PMID 37712803

Authors

Franciani Rodrigues da Rocha

Renata Casagrande Goncalves

Gabriele da Silveira Prestes

Danusa Damasio

Amanda Indalecio Goulart

Andriele Aparecida da Silva Vieira

Monique Michels

Maria Ines da Rosa

Cristiane Ritter

Felipe Dal-Pizzol

Affiliations

Soon will be listed here.

Abstract

Objective: To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit.

Methods: A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge.

Results: Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder.

Conclusion: Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.

Citing Articles

From critical care units to postacute care facilities: the sooner, the better?.

Gusmao-Flores D, Barreto B, Rosa R Crit Care Sci. 2024; 36:e20240145en.

PMID: 39194036 PMC: 11463977. DOI: 10.62675/2965-2774.20240145-en.

To: Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study.

Finsterer J, Scorza F Crit Care Sci. 2024; 36:e20240260en.

PMID: 38922239 PMC: 11152440. DOI: 10.62675/2965-2774.20240260-en.

References

Lee M, Kang J, Jeong Y . Risk factors for post-intensive care syndrome: A systematic review and meta-analysis. Aust Crit Care. 2019; 33(3):287-294. DOI: 10.1016/j.aucc.2019.10.004. View

Tomasi C, Vuolo F, Generoso J, Soares M, Barichello T, Quevedo J . Biomarkers of Delirium in a Low-Risk Community-Acquired Pneumonia-Induced Sepsis. Mol Neurobiol. 2016; 54(1):722-726. DOI: 10.1007/s12035-016-9708-6. View

Mazeraud A, Righy C, Bouchereau E, Benghanem S, Bozza F, Sharshar T . Septic-Associated Encephalopathy: a Comprehensive Review. Neurotherapeutics. 2020; 17(2):392-403. PMC: 7283452. DOI: 10.1007/s13311-020-00862-1. View

MacLullich A, Ferguson K, Miller T, de Rooij S, Cunningham C . Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008; 65(3):229-38. PMC: 4311661. DOI: 10.1016/j.jpsychores.2008.05.019. View

Wintermann G, Petrowski K, Weidner K, Strauss B, Rosendahl J . Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters. Crit Care. 2019; 23(1):39. PMC: 6368748. DOI: 10.1186/s13054-019-2321-0. View

Barichello T, Sayana P, Giridharan V, Arumanayagam A, Narendran B, Giustina A . Long-Term Cognitive Outcomes After Sepsis: a Translational Systematic Review. Mol Neurobiol. 2018; 56(1):186-251. DOI: 10.1007/s12035-018-1048-2. View

Girard T, Thompson J, Pandharipande P, Brummel N, Jackson J, Patel M . Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med. 2018; 6(3):213-222. PMC: 6709878. DOI: 10.1016/S2213-2600(18)30062-6. View

Hughes C, Patel M, Brummel N, Thompson J, McNeil J, Pandharipande P . Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability. Intensive Care Med. 2018; 44(3):345-355. PMC: 5870884. DOI: 10.1007/s00134-018-5120-1. View

Needham D, Davidson J, Cohen H, Hopkins R, Weinert C, Wunsch H . Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2011; 40(2):502-9. DOI: 10.1097/CCM.0b013e318232da75. View

10.

Dinglas V, Friedman L, Colantuoni E, Mendez-Tellez P, Shanholtz C, Ciesla N . Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors. Crit Care Med. 2017; 45(3):446-453. PMC: 5315580. DOI: 10.1097/CCM.0000000000002208. View

11.

Desai S, Law T, Needham D . Long-term complications of critical care. Crit Care Med. 2010; 39(2):371-9. DOI: 10.1097/CCM.0b013e3181fd66e5. View

12.

Brown S, Bose S, Banner-Goodspeed V, Beesley S, Dinglas V, Hopkins R . Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review. Ann Am Thorac Soc. 2019; 16(8):947-956. DOI: 10.1513/AnnalsATS.201812-913FR. View

13.

Marcolino J, Mathias L, Piccinini Filho L, Guaratini A, Suzuki F, Alli L . Hospital Anxiety and Depression Scale: a study on the validation of the criteria and reliability on preoperative patients. Rev Bras Anestesiol. 2009; 57(1):52-62. DOI: 10.1590/s0034-70942007000100006. View

14.

Iwashyna T, Wesley Ely E, Smith D, Langa K . Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010; 304(16):1787-94. PMC: 3345288. DOI: 10.1001/jama.2010.1553. View

15.

Davydow D, Gifford J, Desai S, Bienvenu O, Needham D . Depression in general intensive care unit survivors: a systematic review. Intensive Care Med. 2009; 35(5):796-809. PMC: 10885708. DOI: 10.1007/s00134-009-1396-5. View

16.

Mankowski R, Anton S, Ghita G, Brumback B, Darden D, Bihorac A . Older Adults Demonstrate Biomarker Evidence of the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) After Sepsis. J Gerontol A Biol Sci Med Sci. 2021; 77(1):188-196. PMC: 8751807. DOI: 10.1093/gerona/glab080. View

17.

van Munster B, Korevaar J, Zwinderman A, Levi M, Wiersinga W, de Rooij S . Time-course of cytokines during delirium in elderly patients with hip fractures. J Am Geriatr Soc. 2008; 56(9):1704-9. DOI: 10.1111/j.1532-5415.2008.01851.x. View

18.

Darden D, Brakenridge S, Efron P, Ghita G, Fenner B, Kelly L . Biomarker Evidence of the Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) in Chronic Critical Illness (CCI) After Surgical Sepsis. Ann Surg. 2021; 274(4):664-673. PMC: 8592255. DOI: 10.1097/SLA.0000000000005067. View

19.

Cunningham C . Systemic inflammation and delirium: important co-factors in the progression of dementia. Biochem Soc Trans. 2011; 39(4):945-53. PMC: 4157218. DOI: 10.1042/BST0390945. View

20.

Maciel M, Benedet S, Lunardelli E, Delziovo H, Domingues R, Vuolo F . Predicting Long-term Cognitive Dysfunction in Survivors of Critical Illness with Plasma Inflammatory Markers: a Retrospective Cohort Study. Mol Neurobiol. 2018; 56(1):763-767. DOI: 10.1007/s12035-018-1166-x. View