Psychological and Cognitive Outcomes of Critically Ill COVID-19 Patients at Hospital Discharge

Abstract

RationaleThe novel coronavirus, COVID-19, can cause critical illness in up to 5% of infected patients. Although the sequelae of surviving critical illness are known, limited data exist regarding the psychological and cognitive outcomes specifically in survivors of COVID-19. Given the social isolation, scarcity of multidisciplinary staff, and socio-economic impact of the pandemic, understanding the cognitive and psychological impact of surviving critical illness due to COVID-19 is of utmost importance. MethodsA prospective observational cohort study at an academic medical center enrolled critically ill patients with confirmed COVID-19 infection. Upon hospital discharge, cognitive and psychological sequelae were measured using the following validated assessments: Montreal Cognitive Assessment (MoCA), Impact of Event Score (IES), and the Hospital Anxiety and Depression scale (HADS). Cognitive impairment was defined as a MoCA score 32. Significant symptoms of anxiety and depression were defined as a HADS subscale score of ≥8. ResultsFrom April 10, 2020 through November 17, 2020, 100 adult critically ill patients were enrolled, of which 27 were invasively mechanically ventilated. Eighty-nine patients underwent cognitive and psychological evaluation upon hospital discharge. Of the 11 patients who did not complete the evaluation, 2 died prior to discharge, 4 had significant cognitive impairment, 2 were discharged prior to survey completion, and 3 refused. Cognitive impairment was present in 93% of patients (n=83) with a median MoCA score of 17 [13-22]. Patients with cognitive impairment tended to be older (62 years old [53-71] vs 50 [41-58];p=0.17). Ten patients (11%) had probable PTSD with a median IES score of 4 [0-17] in the overall cohort. Seventeen patients (19%) reported significant depressive symptoms and twenty patients (22%) noted significant symptoms of anxiety. ConclusionPrior coronavirus outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were associated with anxiety, depression, impaired memory and confusion occurring in approximately one-third of patients at hospital discharge. In contrast, cognitive impairment in ICU survivors of COVID-19 infection was nearly universal on hospital discharge. This impairment is not completely explained by coexistent psychiatric symptoms of anxiety or depression, which were present in only one-fifth of the ICU survivors.