Modifiable in-hospital factors for 12-month global cognition, post-traumatic stress disorder symptoms, and depression symptoms in adults hospitalized with COVID-19

Jin H Han; James C Jackson; Onur M Orun; Samuel M Brown; Jonathan D Casey; Lindsay Clark; Sean P Collins; Kemberlyne Cordero; Adit A Ginde; Michelle N Gong; Catherine L Hough; Theodore J Iwashyna; Amy L Kiehl; Alana Lauck; Lindsay M Leither; Christopher J Lindsell; Mayur B Patel; Rameela Raman; Todd W Rice; Nancy J Ringwood; Karen L Sheppard; Matthew W Semler; B Taylor Thompson; E Wesley Ely; Wesley H Self; National Heart, Lung, and Blood Institute PETAL Clinical Trials Network

doi:10.1111/irv.13197

Modifiable in-hospital factors for 12-month global cognition, post-traumatic stress disorder symptoms, and depression symptoms in adults hospitalized with COVID-19

Influenza Other Respir Viruses. 2023 Sep;17(9):e13197. doi: 10.1111/irv.13197.

Authors

Jin H Han^{1

2

3}, James C Jackson^{1

2

4}, Onur M Orun^{1

5}, Samuel M Brown⁶, Jonathan D Casey⁴, Lindsay Clark^{7

8}, Sean P Collins^{2

3}, Kemberlyne Cordero¹, Adit A Ginde⁹, Michelle N Gong¹⁰, Catherine L Hough¹¹, Theodore J Iwashyna^{12

13}, Amy L Kiehl¹, Alana Lauck¹, Lindsay M Leither⁶, Christopher J Lindsell⁵, Mayur B Patel^{1

2

14}, Rameela Raman^{1

5}, Todd W Rice^{4

15}, Nancy J Ringwood¹⁶, Karen L Sheppard¹, Matthew W Semler⁴, B Taylor Thompson¹⁶, E Wesley Ely^{1

2

4}, Wesley H Self^{3

14

15}; National Heart, Lung, and Blood Institute PETAL Clinical Trials Network

Affiliations

¹ Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
³ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Division of Pulmonary/Critical Care Medicine, Department of Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, Utah, USA.
⁷ Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁸ Geriatric Research, Education, and Clinical Center (GRECC), William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
⁹ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹⁰ Division of Critical Care, Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
¹¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
¹² Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
¹³ Health Policy & Management in the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁴ Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁵ Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁶ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Abstract

Background: We sought to identify potentially modifiable in-hospital factors associated with global cognition, post-traumatic stress disorder (PTSD) symptoms, and depression symptoms at 12 months.

Methods: This was a multi-center prospective cohort study in adult hospitalized patients with acute COVID-19. The following in-hospital factors were assessed: delirium; frequency of in-person and virtual visits by friends and family; and hydroxychloroquine, corticosteroid, and remdesivir administration. Twelve-month global cognition was characterized by the MOCA-Blind. Twelve-month PTSD and depression were characterized using the PTSD Checklist for the DSM-V and Hospital Anxiety Depression Scale, respectively.

Findings: Two hundred three patients completed the 12-month follow-up assessments. Remdesivir use was associated with significantly higher cognition at 12 months based on the MOCA-Blind (adjusted odds ratio [aOR] = 1.98, 95% CI: 1.06, 3.70). Delirium was associated with worsening 12-month PTSD (aOR = 3.44, 95% CI: 1.89, 6.28) and depression (aOR = 2.18, 95% CI: 1.23, 3.84) symptoms. Multiple virtual visits per day during hospitalization was associated with lower 12-month depression symptoms compared to those with less than daily virtual visits (aOR = 0.40, 95% CI: 0.19, 0.85).

Conclusion: Potentially modifiable factors associated with better long-term outcomes included remdesivir use (associated with better cognitive function), avoidance of delirium (associated with less PTSD and depression symptoms), and increased virtual interactions with friends and family (associated with less depression symptoms).

Keywords: depression; long-COVID; long-term cognitive impairment; modifiable risk factors; post-traumatic stress disorder.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
COVID-19*
Cognition
Delirium*
Depression / drug therapy
Hospitals
Humans
Prospective Studies
Stress Disorders, Post-Traumatic* / drug therapy
Stress Disorders, Post-Traumatic* / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding