Post-sepsis cognitive impairment and associated risk factors : a systematic review.

Abstract

Introduction: Post-sepsis cognitive impairment is one of the major sequelae observed in survivors ofsepsis. This cognitive impairment can be global or may affect specific domains. A better understandingof these deficits and associated risk factors could influence the care of patients with sepsis.Objective: To perform a systematic review to investigate the presence of cognitive impairment and itsassociated risk factors among patients who survived sepsis.Methods: The search was conducted in MEDLINE (1966 to March 2017) and EMBASE (1988 to March 2017).We included studies with individuals who were 18 years or older with post-sepsis cognitive impairment.Results: We analysed 577 articles. Sixteen studies met the inclusion criteria. More than 74,000,000patients were evaluated in the selected studies. Significant variation was observed in the definitionof sepsis and cognitive impairment. Twelve studies used ACCP/SCCM criteria for sepsis, while cogni-tive impairment was defined per test used. Post-sepsis cognitive impairment was observed in 12.5 to21% of survivors of sepsis. Attention, cognitive flexibility, processing speed, associative learning, visualperception, work memory, verbal memory, and semantic memory were the specific domains affected.Depressive symptoms, central nervous system infection, length of hospitalisation due to infection, andtemporal proximity to the last period of infection were associated with cognitive impairment.Conclusion: The studies are heterogeneous, and there is urgent need for a common language, includ-ing definitions and neuropsychological tests, for the investigation of post-sepsis cognitive impairment.Despite this, there is mounting evidence for the clinical relevance of post-sepsis cognitive impairment.