Loading...
In this observational study, investigators explored the effects of sepsis on cognition and performance of activities of daily living (ADLs). The authors conducted biennial structured interviews of 9223 elders (or their proxies) who were participating in an ongoing cohort study with linked Medicare data. More than 500 were survivors of severe sepsis (defined as new infection with organ failure) and had at least one follow-up interview after sepsis during the 8-year study.
According to previously validated, yet not widely used, cognitive screening methods and cut points, moderate-to-severe cognitive impairment was significantly greater after sepsis than before sepsis occurred (odds ratio, 3.34; 95% confidence interval, 1.53–7.25). The comparable odds ratio after a nonsepsis hospitalization (affecting about 4000 study participants) was nonsignificant. A functional outcome score based on ability to perform ADLs and instrumental ADLs likewise revealed a greater decline and an acceleration of a negative functional trajectory after sepsis versus nonsepsis hospitalizations, although no single functional activity was identified as consistently impaired. To address potential confounders, subgroup analyses adjusting for mechanical ventilation, prehospital functional impairment, and interval hospitalizations (between baseline and sepsis) yielded similar findings, albeit with wider confidence intervals.
Iwashyna TJ et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010 Oct 27; 304:1787.
Comment
The authors acknowledge study limitations, including the lack of a prospective clinical cognitive evaluation and the potential for concomitant diagnoses that could contribute to cognitive and functional impairment but that the charge-based coding strategy could not capture. Also, the interviews preceding sepsis hospitalization show a trend toward advancing cognitive impairment, which may suggest a more insidious mechanism for the reported cognitive decline. However, this analysis will heighten awareness of the long-term outcomes of a relatively common and increasingly survivable condition in hospitalized patients that is currently managed using an acute-care model. These findings presumably will lead to greater scrutiny of “successful” treatment of severe sepsis with the goal of improving long-term patient outcomes.