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. 2023 Oct 4;12(19):6363.
doi: 10.3390/jcm12196363.

Subsyndromal Delirium in Critically Ill Patients-Cognitive and Functional Long-Term Outcomes

Maria Carolina Paulino  1   2   3 , Catarina Conceição  2   4 , Joana Silvestre  1   5 , Maria Inês Lopes  3 , Hernâni Gonçalves  6   7 , Cláudia Camila Dias  6   7 , Rodrigo Serafim  8   9 , Jorge I F Salluh  8   9 , Pedro Póvoa  1   2   10
Affiliations

Subsyndromal Delirium in Critically Ill Patients-Cognitive and Functional Long-Term Outcomes

Maria Carolina Paulino et al. J Clin Med. .

Abstract

Subsyndromal delirium (SSD) in the Intensive Care Unit (ICU) is associated with an increased morbidity with unknown post-discharge functional and cognitive outcomes. We performed a prospective multicenter study to analyze the mental status of patients during their first 72 h after ICU admission and its trajectory, with follow-ups at 3 and 6 months after hospital discharge. Amongst the 106 included patients, SSD occurred in 24.5% (n = 26) and was associated with the duration of mechanical ventilation (p = 0.003) and the length of the ICU stay (p = 0.002). After the initial 72 h, most of the SSD patients (30.8%) improved and no longer had SSD; 19.2% continued to experience SSD and one patient (3.8%) progressed to delirium. The post-hospital discharge survival rate for the SSD patients was 100% at 3 months and 87.5% at 6 months. At admission, 96.2% of the SSD patients were fully independent in daily living activities, 66.7% at 3-month follow-up, and 100% at 6-month follow-up. Most SSD patients demonstrated a cognitive decline from admission to 3-month follow-up and improved at 6 months (IQCODE-SF: admission 3.13, p < 0.001; 3 months 3.41, p = 0.019; 6 months 3.19, p = 0.194). We concluded that early SSD is associated with worse outcomes, mainly a transitory cognitive decline after hospital discharge at 3 months, with an improvement at 6 months. This highlights the need to prevent and identify this condition during ICU stays.

Keywords: ICU; cognitive dysfunction; delirium; long-term outcome; subsyndromal delirium.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow of patients in study cohort. ICU—Intensive Care Unit; RASS—Richmond Agitation-Sedation Scale; ICDSC—Intensive Care Delirium Screening Checklist; and SSD—Subsyndromal delirium.
Figure 2
Figure 2
Cognitive trajectory in the three days after the first 72 h of admission.
Figure 3
Figure 3
Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-SF score), 3 and 6 months after discharge, mean values. Score < 3 indicating improvement; score = 3.0 no change; score > 3 but <3.3 indicating decline in cognition; score ≥ 3.3 indicates an increased probability of cognitive impairment; and score ≥ 3.6 indicates preexisting cognitive impairment. p-value at admission <0.001; p-value at 3 months 0.02; and p-value 6 months 0.19 (Kruskall–Wallis test). Legend: No-D/no-SSD—No-delirium/No-Subsyndromal delirium; and SSD—Subsyndromal delirium.
See this image and copyright information in PMC

References

    1. Cole M.G., McCusker J., Dendukuri N., Han L. The Prognostic Significance of Subsyndromal Delirium in Elderly Medical Inpatients. J. Am. Geriatr. Soc. 2003;51:754–760. doi: 10.1046/j.1365-2389.2003.51255.x. - DOI - PubMed
    1. Ouimet S., Kavanagh B.P., Gottfried S.B., Skrobik Y. Incidence, Risk Factors and Consequences of ICU Delirium. Intensive Care Med. 2007;33:66–73. doi: 10.1007/s00134-006-0399-8. - DOI - PubMed
    1. Fisher G., Roget N. Encyclopedia of Substance Abuse Prevention, Treatment, & Recovery. SAGE Publications; Thousand Oaks, CA, USA: 2014. Diagnostic and Statistical Manual of Mental Disorders.
    1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) American Psychiatric Association; Washington, DC, USA: 2022. p. 679.
    1. Devlin J.W., Skrobik Y., Gélinas C., Needham D.M., Slooter A.J.C., Pandharipande P.P., Watson P.L., Weinhouse G.L., Nunnally M.E., Rochwerg B., et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit. Care Med. 2018;46:e825–e873. doi: 10.1097/CCM.0000000000003299. - DOI - PubMed

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