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Risk factors for dementia after critical illness in elderly Medicare beneficiaries.

Guerra C, Linde-Zwirble WT, Wunsch H - Crit Care (2012)

Bottom Line: No other measured ICU factors, such as need for mechanical ventilation, were independently associated.Among ICU events, infection or severe sepsis, neurologic dysfunction, and acute dialysis were independently associated with a subsequent diagnosis of dementia.Patient prognostication, as well as future research into post-ICU cognitive decline, should focus on these higher-risk subgroups.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Hospitalization increases the risk of a subsequent diagnosis of dementia. We aimed to identify diagnoses or events during a hospitalization requiring critical care that are associated with a subsequent dementia diagnosis in the elderly.

Methods: A cohort study of a random 5% sample of Medicare beneficiaries who received intensive care in 2005 and survived to hospital discharge, with three years of follow-up (through 2008) was conducted using Medicare claims files. We defined dementia using the International Classification of Diseases, 9th edition, clinical modification (ICD-9-CM) codes and excluded patients with any prior diagnosis of dementia or cognitive impairment in the year prior to admission. We used an extended Cox model to examine the association between diagnoses and events associated with the critical illness and a subsequent diagnosis of dementia, adjusting for known risk factors for dementia.

Results: Over the three years of follow-up, dementia was newly diagnosed in 4,519 (17.8%) of 25,368 patients who received intensive care and survived to hospital discharge. After accounting for known risk factors, having an infection (adjusted hazard ratio (AHR) = 1.25; 95% CI, 1.17 to 1.35), or a diagnosis of severe sepsis (AHR = 1.40; 95% CI, 1.28 to 1.53), acute neurologic dysfunction (AHR = 2.06; 95% CI, 1.72 to 2.46), and acute dialysis (AHR = 1.70; 95% CI, 1.30 to 2.23) were all independently associated with a subsequent diagnosis of dementia. No other measured ICU factors, such as need for mechanical ventilation, were independently associated.

Conclusions: Among ICU events, infection or severe sepsis, neurologic dysfunction, and acute dialysis were independently associated with a subsequent diagnosis of dementia. Patient prognostication, as well as future research into post-ICU cognitive decline, should focus on these higher-risk subgroups.

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Cumulative incidence of all mortality and dementia for elderly ICU survivors over three years, adjusting for mortality as a competing risk. The dashed line is the cumulative incidence of all mortality during follow-up. The solid line is the cumulative incidence of dementia after adjusting for mortality as a competing event.
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Figure 2: Cumulative incidence of all mortality and dementia for elderly ICU survivors over three years, adjusting for mortality as a competing risk. The dashed line is the cumulative incidence of all mortality during follow-up. The solid line is the cumulative incidence of dementia after adjusting for mortality as a competing event.

Mentions: After exclusions, the cohort included 25,368 ICU survivors (Figure 1). The average age was 76.6 ± 6.8 years (Table 1). In the cohort, 89.1% were non-Hispanic white, and 52.3% were female. Of all ICU survivors 18.1% had at least one other hospitalization in the prior year and 2.5% had at least one other ICU stay in the prior year. The median ICU length of stay was two days with an IQR one to five days; the median overall hospital length of stay was six days, IQR three to ten days. The average duration of follow-up was 2.5 years, and the overall three year mortality for the cohort was 30.5%, with almost half of all deaths (45%) occurring in the first year (Table 1 and Figure 2). Dementia was diagnosed in 4,519 (17.8%) of all ICU survivors by the end of the three years of follow-up.


Risk factors for dementia after critical illness in elderly Medicare beneficiaries.

Guerra C, Linde-Zwirble WT, Wunsch H - Crit Care (2012)

Cumulative incidence of all mortality and dementia for elderly ICU survivors over three years, adjusting for mortality as a competing risk. The dashed line is the cumulative incidence of all mortality during follow-up. The solid line is the cumulative incidence of dementia after adjusting for mortality as a competing event.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672622&req=5

Figure 2: Cumulative incidence of all mortality and dementia for elderly ICU survivors over three years, adjusting for mortality as a competing risk. The dashed line is the cumulative incidence of all mortality during follow-up. The solid line is the cumulative incidence of dementia after adjusting for mortality as a competing event.
Mentions: After exclusions, the cohort included 25,368 ICU survivors (Figure 1). The average age was 76.6 ± 6.8 years (Table 1). In the cohort, 89.1% were non-Hispanic white, and 52.3% were female. Of all ICU survivors 18.1% had at least one other hospitalization in the prior year and 2.5% had at least one other ICU stay in the prior year. The median ICU length of stay was two days with an IQR one to five days; the median overall hospital length of stay was six days, IQR three to ten days. The average duration of follow-up was 2.5 years, and the overall three year mortality for the cohort was 30.5%, with almost half of all deaths (45%) occurring in the first year (Table 1 and Figure 2). Dementia was diagnosed in 4,519 (17.8%) of all ICU survivors by the end of the three years of follow-up.

Bottom Line: No other measured ICU factors, such as need for mechanical ventilation, were independently associated.Among ICU events, infection or severe sepsis, neurologic dysfunction, and acute dialysis were independently associated with a subsequent diagnosis of dementia.Patient prognostication, as well as future research into post-ICU cognitive decline, should focus on these higher-risk subgroups.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Hospitalization increases the risk of a subsequent diagnosis of dementia. We aimed to identify diagnoses or events during a hospitalization requiring critical care that are associated with a subsequent dementia diagnosis in the elderly.

Methods: A cohort study of a random 5% sample of Medicare beneficiaries who received intensive care in 2005 and survived to hospital discharge, with three years of follow-up (through 2008) was conducted using Medicare claims files. We defined dementia using the International Classification of Diseases, 9th edition, clinical modification (ICD-9-CM) codes and excluded patients with any prior diagnosis of dementia or cognitive impairment in the year prior to admission. We used an extended Cox model to examine the association between diagnoses and events associated with the critical illness and a subsequent diagnosis of dementia, adjusting for known risk factors for dementia.

Results: Over the three years of follow-up, dementia was newly diagnosed in 4,519 (17.8%) of 25,368 patients who received intensive care and survived to hospital discharge. After accounting for known risk factors, having an infection (adjusted hazard ratio (AHR) = 1.25; 95% CI, 1.17 to 1.35), or a diagnosis of severe sepsis (AHR = 1.40; 95% CI, 1.28 to 1.53), acute neurologic dysfunction (AHR = 2.06; 95% CI, 1.72 to 2.46), and acute dialysis (AHR = 1.70; 95% CI, 1.30 to 2.23) were all independently associated with a subsequent diagnosis of dementia. No other measured ICU factors, such as need for mechanical ventilation, were independently associated.

Conclusions: Among ICU events, infection or severe sepsis, neurologic dysfunction, and acute dialysis were independently associated with a subsequent diagnosis of dementia. Patient prognostication, as well as future research into post-ICU cognitive decline, should focus on these higher-risk subgroups.

Show MeSH
Related in: MedlinePlus