Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Introduction: Survivors of critical illness often have prolonged cognitive and functional impairments, and suffer from depression and PTSD. This constellation of symptoms is termed post-intensive care syndrome (PICS). The incidence and severity of PICS following liver transplantation is unknown.
Methods: In this nested cohort of critically ill patients within the BRAIN-ICU study (NEJM 2013), we selected liver transplant patients and collected baseline and in-hospital data. Patients were assessed at 3 and 12 months after discharge with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; population age-adjusted mean [±SD] score 100±15 – lower values indicate worse cognition), the Katz Index and the FAQ to assess activities and instrumental activities of daily living (ADLs and IADLs), the BDI II for depression, and the PTSD checklist.
Results: We enrolled 37 patients with a median [IQR] age of 55 [51, 60] and IQCODE of 3.1 [3, 3.2], indicating no prior cognitive impairment. Accounting for death/loss to follow up, 30 and 27 patients underwent follow up assessments at 3 and 12 months. Table 1 shows that 52% of the cohort developed significant cognitive impairment (RBANS ≤79, a 1.5 SD decrease) at 3 months, persisting in 39% at 12 months. ADL and IADL impairment scores were low and new ADL and IADL impairments (ADL ≥2, FAQ ≥9) were seen in a small proportion of patients. Of the patients with pretransplant ADL impairments (n=4), 3 and 4 had no impairments by 3 and 12 months post transplant. Similar among those with pretransplant IADL impairments (n=5), 4 and 3 were no longer impaired 3 and 12 months post transplant. New depression (BDI-II ≥14) and PTSD (PCL ≥40) affected a small proportion of patients.
Conclusion: Cognitive impairment developed in this cohort after liver transplant, but other manifestations of PICS like poor functional status improved.
|Outcome||3 Months||12 Months|
|RBANS Global Composite Score*||79 [74,90]||85 [74,91]|
|New Cognitive Impairment||52% (15)||39% (9)|
|Katz ADL Score*||0 [0,0]||0 [0,0]|
|New ADL Impairment||4% (1)||5% (1)|
|FAQ IADL Score*||2 [0,3]||0 [0,3]|
|New IADL Impairment||8% (2)||5% (1)|
|BDI-II Total Score*||7 [3,13]||4 [1,10]|
|New Depression||23% (5)||24% (4)|
|PCL Score*||21 [18,28]||19 [17,25]|
|New ICU-related PTSD||7% (2)||4% (1)|
CITATION INFORMATION: Corriveau J., Chandrasekhar R., Geevarghese S. ADL and IADL Limitations Resolve but New Cognitive Impairments Develop in Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Corriveau J, Chandrasekhar R, Geevarghese S. ADL and IADL Limitations Resolve but New Cognitive Impairments Develop in Liver Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/adl-and-iadl-limitations-resolve-but-new-cognitive-impairments-develop-in-liver-transplant-recipients/. Accessed April 6, 2020.
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