Altered mental status is an independent predictor of mortality in hospitalized COVID-19 patients

Kenerly, Marjorie J.; Shah, Priyank; Patel, Hiten; R, Racine; Jani, Yash; Owens, Caroline; George, Varghese; Linder, Daniel F.; Owens, Jack; Hess, David C.

doi:10.1007/s11845-021-02515-4

Cited by 10 publications

(17 citation statements)

References 6 publications

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“…However the particularly deliriogenic nature of COVID-19 infection has meant new-onset delirium may be predictive of COVID-19 infection across both primary and secondary care, as it can be the sole symptom of infection in older patients (GOV.UK, 2020; Poloni et al, 2020;Zazzara et al, 2021). Delirium in COVID-19 is associated with poorer outcomes, including a longer requirement for mechanical ventilation, a greater duration of ICU and hospital admission (Garcez et al, 2020;Kenerly et al, 2021;Khan et al, 2020), poorer physical function (Mcloughlin et al, 2020) and increased mortality (Garcez et al, 2020;Kenerly et al, 2021;Marengoni et al, 2020;Poloni et al, 2020;Rebora et al, 2021;Zerah et al, 2021). More widely, delirium is also associated with both an increased future risk of dementia and further neurocognitive decline in surviving patients (Davis et al, 2017;.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study

Saini

Ghanem

et al. 2021

Aging & Mental Health

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Objectives:We aimed to find the association of inflammation and respiratory failure with delirium in COVID-19 patients. We compare the inflammatory and arterial blood gas markers between patients with COVID-19 delirium and delirium in other medical disorders. Methods: This cross-sectional study used the CHART-DEL, a validated research tool, to screen patients for delirium retrospectively from clinical notes. Inflammatory markers C-reactive protein (CRP) and white cell count (WBC), and the partial pressures of oxygen (PO 2 ) and carbon dioxide (PCO 2 ) were compared between patients with COVID-19 delirium and delirium in other medical disorders. Results: In bivariate analysis, CRP (mg/L) was significantly higher in the COVID-19 group, (81.7 ± 80.0 vs. 58.8 ± 87.7, p = 0.04), and WBC (10 9 /L) was significantly lower (7.44 ± 3.42 vs. 9.71 ± 5.45, p = 0.04). The geometric mean of CRP in the COVID-19 group was 140% higher in multiple linear regression (95% CI = 7-439%, p = 0.03) with age and sex as covariates. There were no significant differences in pO 2 or pCO 2 across groups. Conclusion:The association between higher CRP and COVID-19 in patients with delirium may suggest an inflammatory basis for delirium in COVID-19. Our findings may assist clinicians in establishing whether delirium is due to COVID-19, which may improve management and outcomes of infected patients.

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Section: Introductionmentioning

confidence: 99%

Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study

Saini

Ghanem

et al. 2021

Aging & Mental Health

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“…Although the authors did not specifically analyze Levesque’s framework, they nevertheless utilized terms similar or identical to those in the framework. Half of the studies reported the availability (or lack) of healthcare resources due to financial insecurities, a lack of healthcare insurance, education/knowledge gaps, transportation, Internet/phone or telemedicine, cognitive screening, ambulatory care, and so on ([ 26 , 36 , 37 , 38 , 39 ]) (See Table 4 ). These were grouped as materials, financial insecurities, and knowledge gaps.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, at the healthcare system level, organizational inefficiencies, service abilities, and racialized ageism affecting the attitudes and perceptions of healthcare professionals toward older African American adults may diminish healthcare accessibility [ 23 , 24 , 25 ]. Access to services for older African Americans could be worsened due to their more significant residential mobility issues, reduced cell phone access, and transportation limitations [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources

Udoh

Mpofu

Prybutok

2023

IJERPH

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African American/Black communities comprise 12.2% of the U.S. population, with a COVID-19 infection rate of more than 18% and marginal access to healthcare services. This scoping review synthesizes the emerging evidence on healthcare accessibility among older African American adult communities with dementia and COVID-19, as well as the resource requirements for this population during the pandemic. Searches of different databases for empirical studies and other sources on dementia and COVID-19 among older African American adults yielded 13 studies that met the following inclusion criteria: (a) focus on dementia and COVID-19, (b) sampled older African American adults,(c) investigated healthcare accessibility and resources, and (d) published between 2019 and 2022. Following the initial selection of the studies, eight were selected for relevance based on the Population, Concept, and Context (PCC) inclusion and exclusion criteria. Thematic analysis indicated that older African Americans with dementia and COVID-19 experienced longer delays in accessing timely healthcare, including transportation, intensive care units (ICUs), and mechanical ventilation. They also had reduced healthcare resources associated with a lack of health insurance, low financial resources, and an increased length of hospital stay, which further aggravated the negative effects of comorbid dementia and COVID-19 infections. Evidence showed that racial and age disparities affected older African American adults with dementia and COVID-19, resulting in lower healthcare access and marginal resources. This is consistent with historical and systemic inequities in meeting the healthcare needs of people of color in the United States, which was compounded for older African Americans during the COVID-19 pandemic.

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“…Analysis of a cohort of 710 hospitalized patients found AMS was independently associated with ICU admission and in-hospital mortality. [13] A study of COVID patients presenting to the ED with neurological symptoms found that altered mental status on admission was associated with increased mortality. [14] The association of respiratory symptoms with worse prognoses has also reported by several studies.…”

Section: Discussionmentioning

confidence: 99%

Association of Initial Clinical Characteristics with the Need for the Intensive Care Unit and Hospitalization in Patients Presenting to the Emergency Department with Acute Symptomatic COVID-19

Zollinger¹,

Newton²,

Freeman

et al. 2021

Preprint

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ObjectiveTo evaluate the association of initial clinical symptoms with need for hospitalization, intensive care, or death in ED patients within 30 days after presenting with acute symptomatic COVID-19.MethodsThis study is a retrospective case-series of patients presenting to a single ED with acute symptomatic COVID-19 from March 7–August 9, 2020. Symptomatic patients with laboratory-confirmed SARS-CoV-2 infection were eligible for this study. Patients who tested positive for COVID-19 due to screening tests but had no reasonably associated symptoms were excluded. Participants were analyzed by three categories representative of clinical severity: intensive care unit (ICU) care/death, general ward admission, and ED discharge/convalescence at home. Outcomes were ascertained 30 days after initial presentation to account for escalation in severity after the ED visit. We conducted univariate and multivariable logistic regression analyses to report odds ratios (OR) with 95% confidence intervals (CI) between hospital or ICU care/death versus convalescence at home and between ICU care/death versus general ward admission.ResultsIn total, 994 patients were included in the study, of which, 551 (55.4%) patients convalesced at home, 314 (31.6%) patients required general ward admission, and 129 (13.0%) required ICU care or died. In the multivariable models, ED patients requiring hospital admission were more likely to be aged ≥ 65 years (adjusted OR [aOR] 7.4, 95% CI: 5.0, 10.8), Black/African American (aOR 3.0, 95% CI: 1.6, 5.8) or Asian/American Indian/Alaska Native/Other (aOR 2.2, 95% CI: 1.1, 4.3), and experience dyspnea (aOR 2.7, 95% CI: 2.0, 3.7) or diarrhea (aOR 1.6, 95% CI: 1.1, 2.2). However, they were less likely to experience sore throat (aOR 0.4, 95% CI: 0.2, 0.6), myalgia (aOR 0.5, 95% CI: 0.4, 0.7), headache (aOR 0.5, 95% CI: 0.4, 0.8), or olfactory/taste disturbance (aOR 0.5, 95% CI: 0.3, 0.8). ED patients who required ICU care or died were more likely to experience altered mental status (aOR 3.8, 95% CI: 2.1, 6.6), but were less likely to report history of fever (0.5, 95% CI: 0.3, 0.8).ConclusionsCOVID-19 presents with a multitude of clinical symptoms and an understanding of the association of symptoms with clinical severity may be useful for predicting ultimate patient outcomes.

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Altered mental status is an independent predictor of mortality in hospitalized COVID-19 patients

Cited by 10 publications

References 6 publications

Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study

Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study

Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources

Association of Initial Clinical Characteristics with the Need for the Intensive Care Unit and Hospitalization in Patients Presenting to the Emergency Department with Acute Symptomatic COVID-19

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