Neurol Sci . Critical role of acute hypoxemia on the cognitive impairment after severe COVID-19 pneumonia: a multivariate causality model analysis

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Neurol Sci


. 2022 Jan 13.
doi: 10.1007/s10072-021-05798-8. Online ahead of print.
Critical role of acute hypoxemia on the cognitive impairment after severe COVID-19 pneumonia: a multivariate causality model analysis


Miguel García-Grimshaw ¹ , Amanda Chirino-Pérez ² , Fernando Daniel Flores-Silva ¹ , Sergio Iván Valdés-Ferrer ^{1 3} , María de Los Ángeles Vargas-Martínez ¹ , Ana Itiel Jiménez-Ávila ¹ , Oswaldo Alan Chávez-Martínez ¹ , Enrique Manuel Ramos-Galicia ⁴ , Osvaldo Alexis Marché-Fernández ¹ , Martha Fernanda Ramírez-Carrillo ⁴ , Samara Lissete Grajeda-González ¹ , Marco Eduardo Ramírez-Jiménez ¹ , Emma Adriana Chávez-Manzanera ⁵ , María Teresa Tusié-Luna ^{6 7} , Ana Ochoa-Guzmán ⁶ , Carlos Cantú-Brito ¹ , Juan Fernandez-Ruiz ^{8 9} , Erwin Chiquete ¹⁰



Affiliations

• PMID: 35022935
• DOI: 10.1007/s10072-021-05798-8

Abstract

Background: A high proportion of coronavirus disease 2019 (COVID-19) survivors may develop long-term cognitive impairment. We aimed to develop a multivariate causal model exposing the links between COVID-19-associated biomarkers, illness-related variables, and their effects on cognitive performance.
Methods: In this prospective study, we assess the potential drivers for the development of cognitive impairment in patients with severe COVID-19 pneumonia aged ≥ 18 years at 6-month follow-up after hospital discharge, using the Montreal Cognitive Assessment (MoCA). Patients with pre-existing cognitive impairment were excluded. Laboratory results at hospital admission were clustered by principal component analysis (PCA) and included in a path analysis model evaluating the causal relationship between age, comorbidities, hypoxemia, invasive mechanical ventilation (IMV) requirement, in-hospital delirium, and cognitive performance.
Results: We studied 92 patients: 54 (58.7%) men and 38 (41.3%) women, with median age of 50 years (interquartile range 42-55), among whom 50 (54.4%) tested positive for cognitive impairment at 6-month follow-up. Path analysis revealed a direct link between the thrombo-inflammatory component of PCA (C-reactive protein, fibrinogen, and neutrophils) and hypoxemia severity at hospital admission. Our model showed that low PaO₂/FiO₂ ratio values, unlike the thrombo-inflammatory component, had a direct effect on cognitive performance, independent from age, in-hospital delirium, and invasive mechanical ventilation.
Conclusion: In this study, biomarkers of thrombo-inflammation in COVID-19 and low PaO₂/FiO₂ had a negative effect on cognitive performance 6 months after hospital discharge. These results highlight the critical role of hypoxemia as a driver for impaired cognition in the mid-term.

Keywords: COVID-19; Cognition; Cognitive impairment; Hospitalization; Inflammation; Outcome; SARS-CoV-2.