tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Amanda Chirino-Pérez[SUP] 2 [/SUP], Fernando Daniel Flores-Silva[SUP] 1 [/SUP], Sergio Iván Valdés-Ferrer[SUP] 1 3 [/SUP], María de Los Ángeles Vargas-Martínez[SUP] 1 [/SUP], Ana Itiel Jiménez-Ávila[SUP] 1 [/SUP], Oswaldo Alan Chávez-Martínez[SUP] 1 [/SUP], Enrique Manuel Ramos-Galicia[SUP] 4 [/SUP], Osvaldo Alexis Marché-Fernández[SUP] 1 [/SUP], Martha Fernanda Ramírez-Carrillo[SUP] 4 [/SUP], Samara Lissete Grajeda-González[SUP] 1 [/SUP], Marco Eduardo Ramírez-Jiménez[SUP] 1 [/SUP], Emma Adriana Chávez-Manzanera[SUP] 5 [/SUP], María Teresa Tusié-Luna[SUP] 6 7 [/SUP], Ana Ochoa-Guzmán[SUP] 6 [/SUP], Carlos Cantú-Brito[SUP] 1 [/SUP], Juan Fernandez-Ruiz[SUP] 8 9 [/SUP], Erwin Chiquete[SUP] 10 [/SUP]
Affiliations
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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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.
. 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[SUP] 1 [/SUP], Amanda Chirino-Pérez[SUP] 2 [/SUP], Fernando Daniel Flores-Silva[SUP] 1 [/SUP], Sergio Iván Valdés-Ferrer[SUP] 1 3 [/SUP], María de Los Ángeles Vargas-Martínez[SUP] 1 [/SUP], Ana Itiel Jiménez-Ávila[SUP] 1 [/SUP], Oswaldo Alan Chávez-Martínez[SUP] 1 [/SUP], Enrique Manuel Ramos-Galicia[SUP] 4 [/SUP], Osvaldo Alexis Marché-Fernández[SUP] 1 [/SUP], Martha Fernanda Ramírez-Carrillo[SUP] 4 [/SUP], Samara Lissete Grajeda-González[SUP] 1 [/SUP], Marco Eduardo Ramírez-Jiménez[SUP] 1 [/SUP], Emma Adriana Chávez-Manzanera[SUP] 5 [/SUP], María Teresa Tusié-Luna[SUP] 6 7 [/SUP], Ana Ochoa-Guzmán[SUP] 6 [/SUP], Carlos Cantú-Brito[SUP] 1 [/SUP], Juan Fernandez-Ruiz[SUP] 8 9 [/SUP], Erwin Chiquete[SUP] 10 [/SUP]
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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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.