Clinical question: Are acute blood biomarker profiles predictive of cognitive deficits following COVID-19 hospitalizations?
Background: Cognitive deficits have been observed in many patients after COVID-19 hospitalizations, with one study showing one in eight patients receiving their first-ever neurological or psychiatric diagnosis within six months after COVID-19. The mechanism remains unknown and it’s unclear if specific biomarker profiles can predict cognitive deficits post-COVID-19 hospitalization.
Study design: Multicenter, prospective cohort study
Setting: 83 hospitals across the United Kingdom
Synopsis: This study investigated 1,837 patients from the posthospitalization COVID-19 (PHOSP-COVID) cohort (average age 57.9, 36.6% female) to determine whether blood biomarkers could predict cognitive deficits post-COVID-19 hospitalization.
Six biomarkers were measured upon hospital admission, namely C-reactive protein (CRP), D-dimer, fibrinogen, lymphocyte, neutrophil, and platelet counts. Cognitive assessments, including the Montreal Cognitive Assessment (MoCA) for objective deficits and the Patient Symptom Questionnaire (C-PSQ) for subjective deficits, were conducted at six and 12 months post-hospitalization.
The study found elevated fibrinogen levels relative to CRP were associated with both objective and subjective cognitive deficits (lower MoCA scores and higher C-PSQ scores). Elevated D-dimer relative to CRP was associated with subjective cognitive deficit (higher C-PSQ scores), and signs of occupational impact. These associations were validated in a separate dataset of more than 90 million patients as not attributable to pre-COVID-19 cognitive function. The study’s observational nature is a limitation, and while the associations weren’t significantly mediated by depression or anxiety, fatigue and dyspnea partly mediated elevated D-dimer levels’ association with cognitive deficits.
Bottom line: Elevated fibrinogen or D-dimer levels relative to CRP are associated with cognitive deficits at six and 12 months post-COVID-19 hospitalization.
Citation: Taquet M, Skorniewska Z, et al. Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization. Nat Med. 2023;29(10):2498-508.
Dr. Siau
Dr. Siau is a hospitalist in the division of hospital medicine at the Mount Sinai Health System and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.