Modifiable in-hospital factors for 12-month global cognition, post-traumatic stress disorder symptoms, and depression symptoms in adults hospitalized with COVID-19

Jin H Han^{1

2

3}, James C Jackson^{1

2

4}, Onur M Orun^{1

5}, Samuel M Brown⁶, Jonathan D Casey⁴, Lindsay Clark^{7

8}, Sean P Collins^{2

3}, Kemberlyne Cordero¹, Adit A Ginde⁹, Michelle N Gong¹⁰, Catherine L Hough¹¹, Theodore J Iwashyna^{12

13}, Amy L Kiehl¹, Alana Lauck¹, Lindsay M Leither⁶, Christopher J Lindsell⁵, Mayur B Patel^{1

2

14}, Rameela Raman^{1

5}, Todd W Rice^{4

15}, Nancy J Ringwood¹⁶, Karen L Sheppard¹, Matthew W Semler⁴, B Taylor Thompson¹⁶, E Wesley Ely^{1

2

4}, Wesley H Self^{3

14

15}; National Heart, Lung, and Blood Institute PETAL Clinical Trials Network

Affiliations

¹ Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
³ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Division of Pulmonary/Critical Care Medicine, Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, Utah, USA.
⁷ Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁸ Geriatric Research, Education, and Clinical Center (GRECC), William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
⁹ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹⁰ Division of Critical Care, Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
¹¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
¹² Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
¹³ Health Policy & Management in the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁴ Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁵ Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁶ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

PMID: 37752063
PMCID: PMC10522479
DOI: 10.1111/irv.13197

Modifiable in-hospital factors for 12-month global cognition, post-traumatic stress disorder symptoms, and depression symptoms in adults hospitalized with COVID-19

Jin H Han et al. Influenza Other Respir Viruses. 2023 Sep.

. 2023 Sep;17(9):e13197.

doi: 10.1111/irv.13197.

Authors

Affiliations

¹ Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
³ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Division of Pulmonary/Critical Care Medicine, Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, Utah, USA.
⁷ Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁸ Geriatric Research, Education, and Clinical Center (GRECC), William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
⁹ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹⁰ Division of Critical Care, Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
¹¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
¹² Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
¹³ Health Policy & Management in the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁴ Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁵ Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁶ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

PMID: 37752063
PMCID: PMC10522479
DOI: 10.1111/irv.13197

Abstract

Background: We sought to identify potentially modifiable in-hospital factors associated with global cognition, post-traumatic stress disorder (PTSD) symptoms, and depression symptoms at 12 months.

Methods: This was a multi-center prospective cohort study in adult hospitalized patients with acute COVID-19. The following in-hospital factors were assessed: delirium; frequency of in-person and virtual visits by friends and family; and hydroxychloroquine, corticosteroid, and remdesivir administration. Twelve-month global cognition was characterized by the MOCA-Blind. Twelve-month PTSD and depression were characterized using the PTSD Checklist for the DSM-V and Hospital Anxiety Depression Scale, respectively.

Findings: Two hundred three patients completed the 12-month follow-up assessments. Remdesivir use was associated with significantly higher cognition at 12 months based on the MOCA-Blind (adjusted odds ratio [aOR] = 1.98, 95% CI: 1.06, 3.70). Delirium was associated with worsening 12-month PTSD (aOR = 3.44, 95% CI: 1.89, 6.28) and depression (aOR = 2.18, 95% CI: 1.23, 3.84) symptoms. Multiple virtual visits per day during hospitalization was associated with lower 12-month depression symptoms compared to those with less than daily virtual visits (aOR = 0.40, 95% CI: 0.19, 0.85).

Conclusion: Potentially modifiable factors associated with better long-term outcomes included remdesivir use (associated with better cognitive function), avoidance of delirium (associated with less PTSD and depression symptoms), and increased virtual interactions with friends and family (associated with less depression symptoms).

Keywords: depression; long-COVID; long-term cognitive impairment; modifiable risk factors; post-traumatic stress disorder.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

**FIGURE 1**
Impairments of individual cognitive domains among 201 patients hospitalized for COVID‐19 who completed neurocognitive testing. Proportions of patients with Z‐scores ≤−1.5 and ≤−2.0, which present 1.5 (moderate impairment) and 2.0 (severe impairment) standard deviations (SD) below the population mean for each cognitive test in all patients. Z‐scores were calculated by subtracting the cognitive domain score from the cognitive test's population mean and dividing by the cognitive test's population standard deviation. Moderate impairments (≤−1.5 SD below the population mean) in 12‐month executive function, immediate memory, and delayed memory were observed in 49.6%, 47.5%, and 50.3% of hospitalized COVID‐19 survivors, respectively. Severe impairments (≤−2.0 SD below the population mean) in 12‐month executive function, immediate memory, and delayed memory were observed in 33.3%, 27.8%, and 34.6% of hospitalized COVID‐19 survivors, respectively.

**FIGURE 2**
The association between potentially modifiable in‐hospital factors during the treatment of acute COVID‐19 and 12‐month global cognition as characterized by the (A) Cognitive Composite Score based on a detailed neuropsychological battery and (B) MOCA‐Blind in using proportional odds logistic regression. The full models can be seen in Figure S2. Remdesivir use during hospitalization was associated with improved 12‐month global cognition characterized by the MOCA‐Blind (aOR = 1.98, 95% CI: 1.06, 3.70). The aOR for remdesivir use on 12‐month global cognition as characterized by the Cognitive Composite Score was 1.57 (95% CI: 0.84, 2.94).

**FIGURE 3**
The association between potentially modifiable in‐hospital factors during the treatment of acute COVID‐19 and 12‐month (A) post‐traumatic stress disorder (PTSD) symptoms as characterized by the PTSD Checklist for the DSM‐V (PCL‐5) and (B) depression symptoms as characterized by Hospital Anxiety Depression Scale (HADS)–Depression subscale using proportional odds logistic regression. The full model can be seen in Figure S9. Delirium during hospitalization was associated with higher 12‐month PTSD symptom severity (aOR = 3.44, 95% CI: 1.89, 6.28) and higher depression symptom severity (aOR = 2.18, 95% CI: 1.23, 3.84). Having multiple virtual visits per day from friends or family during hospitalization was associated with better 12‐month depression symptom severity (aOR = 0.40, 95% CI: 0.19, 0.85) compared to those who had less than daily virtual visits.

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References

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Modifiable in-hospital factors for 12-month global cognition, post-traumatic stress disorder symptoms, and depression symptoms in adults hospitalized with COVID-19

Affiliations

Modifiable in-hospital factors for 12-month global cognition, post-traumatic stress disorder symptoms, and depression symptoms in adults hospitalized with COVID-19

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical