COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study

Abstract

Background Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay. Methods In this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols. Results A total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those < 45 years old (aOR 8.7; 95% CI 2.2, 33.5; P = 0.003). Delirium was associated with increased odds of safety attendant use (aOR 4.5; 95% CI 1.0, 20.7; P = 0.050), decreased odds of discharge home (aOR 0.2; 95% CI 0.06, 0.6; P = 0.005), and increased length of stay (aOR 7.5; 95% CI 2.0, 13; P = 0.008). Conclusions While delirium is common in hospitalized patients of all ages with COVID-19, it is especially common in those with severe disease on hospital admission and those who are older. Patients with COVID-19 and delirium, compared to COVID-19 without delirium, are more likely to require safety attendants during hospitalization, less likely to be discharged home, and have a longer length of stay. Individuals with COVID-19, including younger patients, represent an important population to target for delirium screening and management as delirium is associated with important differences in both clinical care and disposition.

Delirium in a Young Predominantly Hispanic Population with COVID-19

“…Previous studies have shown neurological manifestations such as delirium were found to be associated with more severe disease presentation and higher mortality rates. 23,24 This suggests delirium is an indicator of a poorer prognosis in COVID-19 patients, which is consistent with previous studies though these studies tend to be oriented towards older patient populations. 3,16,17 This study showed delirium was significantly associated with worse patient outcomes including longer hospital stay, longer ICU stay, higher rates of mechanical ventilation, more days on mechanical ventilation and higher mortality in this younger, predominantly Hispanic population.…”

“…Our results are consistent with previous literature that indicates delirium is associated with worse health outcomes in COVID-19 patients. 16,22,24 In terms of psychiatric history, patients diagnosed with delirium had pre-existing cognitive deficits and history of substance use. Cognitive deficits have been found in older patients to be associated with development of delirium, and we see here a confirmation of studies suggesting that association is also true in younger patients.…”

“…Our results are consistent with previous literature that indicates delirium is associated with worse health outcomes in COVID-19 patients. 16,22,24…”

A importância do diagnóstico precoce do delirium em pacientes idosos com Covid-19

“…Estudos confirmam que a síndrome aguda grave por coronavírus pode ser responsável por doenças neurológicas, devido a um efeito direto da invasão viral no sistema nervoso central, a mediadores inflamatórios induzidos pela infecção, a fatores da doença e do próprio tratamento para Covid-19. Devido a isso os pacientes podem apresentar alterações da consciência e distúrbios de cognição (Benussi et al, 2020;Helms et al, 2020;Hariyanto et al, 2021;Shao et al, 2021;Lahue et al, 2022).…”

“…Ainda, Neto et al (2021) Finalmente, vale ressaltar que a investigação do tratamento ou prevenção do delirium é crucial e implementa práticas para recuperação. Assim, é de importância dos profissionais de saúde a avaliação do delirium e a monitoração dos sintomas em pacientes com Covid-19, a fim de que ocorra uma organização e um diagnóstico precoce desses pacientes, evitando o alto índice de mortalidade (Benussi et al, 2020;Helms et al, 2020;Hariyanto et al, 2021;Shao et al, 2021;Lahue et al, 2022).…”