Inflammation and Coagulation During Critical Illness and Long-Term Cognitive Impairment and Disability
Nathan E. Brummel, Christopher G. Hughes, Jennifer L. Thompson, James C. Jackson, Pratik P. Pandharipande, J. Brennan McNeil, Rameela Chandrasekhar, Onur M Orun, Lorraine B. Ware, Gordon R. Bernard, E. Wesley Ely, Timothy D. Girard
Abstract
Abstract Rationale The biological mechanisms of long-term cognitive impairment and disability after critical illness are unclear. Objectives To test the hypothesis that markers of acute inflammation and coagulation are associated with subsequent long-term cognitive impairment and disability. Methods We obtained plasma samples from adults with respiratory failure or shock on Study Days 1, 3, and 5 and measured concentrations of CRP (C-reactive protein), IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12, MMP-9 (matrix metalloproteinase-9), TNF-α (tumor necrosis factor-α), soluble TNF receptor 1, and protein C. At 3 and 12 months after discharge, we assessed global cognition, executive function, and activities of daily living. We analyzed associations between markers and outcomes using multivariable regression, adjusting for age, sex, education, comorbidities, baseline cognition, doses of sedatives and opioids, stroke risk (in cognitive models), and baseline disability scores (in disability models). Measurements and Main Results We included 548 participants who were a median (interquartile range) of 62 (53–72) years old, 88% of whom were mechanically ventilated, and who had an enrollment Sequential Organ Failure Assessment score of 9 (7–11). After adjusting for covariates, no markers were associated with long-term cognitive function. Two markers, CRP and MMP-9, were associated with greater disability in basic and instrumental activities of daily living at 3 and 12 months. No other markers were consistently associated with disability outcomes. Conclusions Markers of systemic inflammation and coagulation measured early during critical illness are not associated with long-term cognitive outcomes and demonstrate inconsistent associations with disability outcomes. Future studies that pair longitudinal measurement of inflammation and related pathways throughout the course of critical illness and during recovery with long-term outcomes are needed.