Severe Sepsis Associated With Development of Cognitive and Functional Disability in Older Patients

Older adults who survived severe sepsis were more likely to develop substantial cognitive impairment and functional disability, according to a study in the Journal of the American Medical Association.

“Although severe sepsis is the most common non-cardiac cause of critical illness, the long-term impact of severe sepsis on cognitive and physical functioning is unknown,” the authors wrote.

Theodore J. Iwashyna, MD, PhD, of the University of Michigan Medical School, Ann Arbor, and colleagues examined whether an episode of severe sepsis increased the odds of subsequent worsened cognitive impairment and functional disability among survivors. The study involved 1,194 patients with 1,520 hospitalizations for severe sepsis from the Health and Retirement Study, a nationally representative survey of U.S. residents from 1998 to 2006. A total of 9,223 respondents had a cognitive and functional assessment at the beginning of the study and also had linked Medicare claims; 516 survived severe sepsis and 4,517 survived a non-sepsis hospitalization to at least one follow-up survey and were included in the analysis. The presence of cognitive impairment was assessed, as was the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance. The average age of survivors at hospitalization was 76.9 years.

The researchers found that the prevalence of moderate to severe cognitive impairment increased 10.6% among patients who survived severe sepsis, and their odds of acquiring moderate to severe cognitive impairment were 3.3 times higher. Also, a high rate of new functional limitations was seen following sepsis, with an additional average increase of 1.5 new functional limitations per person among those with no or mild to moderate pre-existing functional limitations.

Non-sepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment and with the development of fewer new limitations.

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