Cerebrovascular damage in covid-19 icu survivors

SESSION TITLE: Outcomes and Survival From the ICU SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: Nearly 50% of hospitalized COVID-19 patients have persistent cognitive impairment after hospitalization, but the underlying pathophysiology is not well-characterized. In the acute phase of illness, COVID-19 ICU patients have pronounced cerebrovascular damage. However, longitudinal neuroimaging studies are needed to determine whether vascular damage may contribute to persistent cognitive impairment in COVID-19 ICU survivors. METHODS: We enrolled ICU patients hospitalized at two academic tertiary hospitals who were ≥ 50 years, had an episode of critical illness from acute respiratory failure or sepsis, and were able to safely complete a 3T brain MRI. Those who had PCR-confirmed SARS-CoV-2 infection and were admitted for critical illness from COVID-19 acute respiratory failure were assigned to the COVID-19 ICU survivor group. Those who were admitted for acute respiratory failure and tested negative for SARS-CoV-2 on admission were assigned to the non-COVID-19 ICU survivor group. Patients completed a follow-up visit 1-3 months after discharge which included a blood draw, cognitive testing, and MRI scan. The MRI protocol included structural scans (T1-weighted MPRAGE 3D) to measure atrophy, 3D FLAIR to measure lacunar infarcts and WMHI, diffusion tensor imaging (DTI) to measure white matter integrity, and pseudo-continuous arterial spin labeling to measure cerebral blood flow, and susceptibility weighted imaging (SWI) for identification of cerebral microhemorrhages. We created a control group by matching these ICU survivors to 17 older adults who enrolled in the Indiana Alzheimer’s Disease Center (ADRC) and who were cognitively normal or had mild cognitive impairment based on demographics (age, sex, and race) and MoCA total score. We then compared neuroimaging measures of cerebrovascular damage (white matter hyperintensities) and brain atrophy between all 3 groups using ANCOVA analyses. We controlled for age and sex in all analyses, as well as total intracranial volume in the atrophy analyses. RESULTS: Table 1 describes the demographics of the ICU survivor cohort. In brief, this was a diverse cohort in terms of race, ethnicity, and socioeconomic status (29.4% Black, 5.9% Hispanic, 94.1% >50% ADI). ICU survivors showed a trend for greater cerebrovascular damage, which was greatest in the COVID-19 ICU survivors relative to ADRC participants (p=0.28; Figure 1A). Finally, ICU survivors showed more brain atrophy in the parietal lobe, temporal lobe, and global cortex relative to ADRC participants (all p<0.05; Figure 1B-D). These differences were most significant for the non-COVID ICU group, although the variance is high in this group given the small sample size. CONCLUSIONS: These initial findings support the need for further studies to better understand whether COVID-19 critical illness may be associated with neurodegenerative and vascular pathology. CLINICAL IMPLICATIONS: Findings suggest an association between COVID-19 ICU survivor and non-COVID-19 ICU survivor related persistent cognitive impairment. Further studies are needed to determine whether vascular damage contributes to this persistent cognitive impairment to guide the development of future ICU care and novel intervention. DISCLOSURES: No relevant relationships by Babar Khan No relevant relationships by Sikandar Khan Hayat No relevant relationships by Erika Leary No relevant relationships by Shannon Risacher No relevant relationships by Marielle Siebert No relevant relationships by Brett Walker No relevant relationships by Sophia Wang