Delirium in COVID-19: epidemiology and clinical correlations in a large group of patients admitted to an academic hospital

Abstract

Background Delirium incidence and clinical correlates in coronavirus disease-19 (COVID-19) pneumonia are still poorly investigated. Aim To describe the epidemiology of delirium in patients hospitalized for suspect COVID-19 pneumonia during the pandemic peak in an academic hospital of Northern Italy, identify its clinical correlations and evaluate the association with mortality. Methods The clinical records of 852 patients admitted for suspect COVID-19 pneumonia, defined as respiratory symptoms or fever or certain history of contact with COVID-19 patients, plus chest CT imaging compatible with alveolar-interstitial pneumonia, were retrospectively analyzed. Delirium was defined after careful revision of daily clinical reports in accordance with the Confusion Assessment Method criteria. Data on age, clinical presentation, comorbidities, drugs, baseline lab tests and outcome were collected. The factors associated with delirium, and the association of delirium with mortality, were evaluated through binary logistic regression models. Results Ninety-four patients (11%) developed delirium during stay. They were older (median age 82, interquartile range, IQR 78–89, vs 75, IQR 63–84, p < 0.001), had more neuropsychiatric comorbidities and worse respiratory exchanges at baseline. At multivariate models, delirium was independently and positively associated with age [odds ratio (OR) 1.093, 95% confidence interval (CI) 1.046–1.143, p < 0.001], use of antipsychotic drugs (OR 4.529, 95% CI 1.204–17.027, p = 0.025), serum urea and lactate-dehydrogenase at admission. Despite a higher mortality in patients with delirium (57% vs 30%), this association was not independent of age and respiratory parameters. Conclusions Delirium represents a common complication of COVID-19 and a marker of severe disease course, especially in older patients with neuropsychiatric comorbidity.

Delirium in Patients with SARS‐CoV‐2 Infection: A Multicenter Study

“…The finding that dementia, pre‐existing comorbidity and pulmonary opacity were significantly associated with delirium on admission was somewhat expected according to previous literature 5,26,27 . However, a recent study found that age, history of epilepsy, antipsychotic drugs, vasodilators, urea and lactate dehydrogenase, but not dementia and comorbidity were associated with delirium 15 . The present study, thus, adds knowledge in this field.…”

Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

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The Many Faces of Covid-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy

“…In future months, psychiatrists foresee increased rates for depression and anxiety syndromes. About 11% of Covid-19 cases have delirium ( 55 ). These are older patients with neuropsychiatric comorbidities and worse respiratory conditions.…”