The cognitive and functional consequences of severe sepsis

January 01, 0001

The cognitive and functional consequences of severe sepsis

The long-term cognitive and functional impact in survivors of sepsis has not been characterized. These US researchers attempted to determine the change in cognitive impairment and physical functioning among survivors of severe sepsis while controlling for their previous functioning. They performed a prospective cohort of patients with severe sepsis using data from the Health and Retirement Study. A total of 9223 respondents had both baseline cognitive and functional assessment and had linked Medicare claims. Of these, 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey. Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the assess functioning regarding activities of daily living (ADLs) and instrumental ADLs (IADLs.

The researchers found: "Survivors' mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis. In those with no limits before sepsis, a mean 1.57 new limitations, and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations. In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48, and mean among those with mild to moderate limits, 0.43). The declines in cognitive and physical function persisted for at least 8 years."

The researchers concluded: "Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients' ability to live independently."

This study finds significant and long lasting cognitive and functional impairment in geriatric survivors of severe sepsis.

For the full abstract, click here.

JAMA 304(16): 1787-1794, 27 October 2010 © 2010 American Medical Association
Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. Theodore J. Iwashyna, E. Wesley Ely, Dylan M. Smith, Kenneth M. Langa.

Category: N. Neurological. Keywords: sepsis, cognition, functional capacity, ADLs, geriatrics, prospective cohort trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 9 November 2010

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