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Abstract：
OBJECTIVE: To identify the prevalence and associated factors of cognitive dysfunction, 1 year after ICU discharge, among adult patients, and it´s relation with quality of life.
METHODS: Multicenter, prospective cohort study including ICUs of 10 tertiary hospitals in Brazil, between May 2014 and December 2018. The patients included were 452 adult ICU survivors (median age 60; 47.6% women) with an ICU stay greater than 72 h.
RESULTS: At 12 months after ICU discharge, a Montreal Cognitive Assessment (tMOCA) telephone score of less than 12 was defined as cognitive dysfunction. At 12 months, of the 452 ICU survivors who completed the cognitive evaluation 216 (47.8%) had cognitive dysfunction. In multivariable analyses, the factors associated with long-term (1-year) cognitive dysfunction were older age (Prevalence Ratio-PR = 1.44, P < 0.001), absence of higher education (PR = 2.81, P = 0.005), higher comorbidities on admission (PR = 1.089; P = 0.004) and delirium (PR = 1.13, P < 0.001). Health-related Quality of life (HRQoL), assessed by the mental and physical dimensions of the SF-12v2, was significantly better in patients without cognitive dysfunction (Mental SF-12v2 Mean difference = 2.54; CI 95%, - 4.80/- 0.28; p = 0.028 and Physical SF-12v2 Mean difference = - 2.85; CI 95%, - 5.20/- 0.50; P = 0.018).
CONCLUSIONS: Delirium was found to be the main modifiable predictor of long-term cognitive dysfunction in ICU survivors. Higher education consistently reduced the probability of having long-term cognitive dysfunction. Cognitive dysfunction significantly influenced patients\' quality of life, leading us to emphasize the importance of cognitive reserve for long-term prognosis after ICU discharge.
METHODS: Multicenter, prospective cohort study including ICUs of 10 tertiary hospitals in Brazil, between May 2014 and December 2018. The patients included were 452 adult ICU survivors (median age 60; 47.6% women) with an ICU stay greater than 72 h.
RESULTS: At 12 months after ICU discharge, a Montreal Cognitive Assessment (tMOCA) telephone score of less than 12 was defined as cognitive dysfunction. At 12 months, of the 452 ICU survivors who completed the cognitive evaluation 216 (47.8%) had cognitive dysfunction. In multivariable analyses, the factors associated with long-term (1-year) cognitive dysfunction were older age (Prevalence Ratio-PR = 1.44, P < 0.001), absence of higher education (PR = 2.81, P = 0.005), higher comorbidities on admission (PR = 1.089; P = 0.004) and delirium (PR = 1.13, P < 0.001). Health-related Quality of life (HRQoL), assessed by the mental and physical dimensions of the SF-12v2, was significantly better in patients without cognitive dysfunction (Mental SF-12v2 Mean difference = 2.54; CI 95%, - 4.80/- 0.28; p = 0.028 and Physical SF-12v2 Mean difference = - 2.85; CI 95%, - 5.20/- 0.50; P = 0.018).
CONCLUSIONS: Delirium was found to be the main modifiable predictor of long-term cognitive dysfunction in ICU survivors. Higher education consistently reduced the probability of having long-term cognitive dysfunction. Cognitive dysfunction significantly influenced patients\' quality of life, leading us to emphasize the importance of cognitive reserve for long-term prognosis after ICU discharge.
摘要：
目的：确定认知功能障碍的患病率和相关因素，ICU出院后1年，在成年患者中，这与生活质量有关。
方法：多中心，前瞻性队列研究，包括巴西10家三级医院的ICU，2014年5月至2018年12月。患者包括452名成年ICU幸存者（中位年龄60岁；47.6％的女性），ICU停留时间超过72小时。
结果：ICU出院后12个月，a蒙特利尔认知评估(tMOCA)电话评分小于12分定义为认知功能障碍.12个月时,在完成认知评估的452名ICU幸存者中,216名(47.8%)存在认知功能障碍.在多变量分析中，与长期（1年）认知功能障碍相关的因素是年龄（患病率比率-PR=1.44，P<0.001），缺乏高等教育(PR=2.81，P=0.005)，入院时合并症较高(PR=1.089;P=0.004)和谵妄(PR=1.13,P<0.001)。健康相关生活质量（HRQoL），通过SF-12v2的精神和身体维度评估，在没有认知功能障碍的患者中显著更好(精神SF-12v2平均差异=2.54；CI95%，-4.80/-0.28；p=0.028和物理SF-12v2平均差=-2.85；CI95%，-5.20/-0.50；P=0.018）。
结论：谵妄被发现是ICU幸存者长期认知功能障碍的主要可改变的预测因子。高等教育不断降低长期认知功能障碍的可能性。认知功能障碍显著影响患者的生活质量，导致我们强调认知储备对ICU出院后长期预后的重要性。
方法：多中心，前瞻性队列研究，包括巴西10家三级医院的ICU，2014年5月至2018年12月。患者包括452名成年ICU幸存者（中位年龄60岁；47.6％的女性），ICU停留时间超过72小时。
结果：ICU出院后12个月，a蒙特利尔认知评估(tMOCA)电话评分小于12分定义为认知功能障碍.12个月时,在完成认知评估的452名ICU幸存者中,216名(47.8%)存在认知功能障碍.在多变量分析中，与长期（1年）认知功能障碍相关的因素是年龄（患病率比率-PR=1.44，P<0.001），缺乏高等教育(PR=2.81，P=0.005)，入院时合并症较高(PR=1.089;P=0.004)和谵妄(PR=1.13,P<0.001)。健康相关生活质量（HRQoL），通过SF-12v2的精神和身体维度评估，在没有认知功能障碍的患者中显著更好(精神SF-12v2平均差异=2.54；CI95%，-4.80/-0.28；p=0.028和物理SF-12v2平均差=-2.85；CI95%，-5.20/-0.50；P=0.018）。
结论：谵妄被发现是ICU幸存者长期认知功能障碍的主要可改变的预测因子。高等教育不断降低长期认知功能障碍的可能性。认知功能障碍显著影响患者的生活质量，导致我们强调认知储备对ICU出院后长期预后的重要性。
