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.…”

“…comorbidity were associated with delirium. 15 The present study, thus, adds knowledge in this field.…”

“…To date, delirium prevalence in COVID-19 varies greatly between studies, with some, published in the early months of the pandemic, reporting high or very high rates, 3,[8][9][10][11] and other more recent ones finding lower prevalence. [12][13][14] Furthermore, there are only a few studies that have investigated the risk factors of delirium in patients with COVID-19 15,16 and there are contrasting findings regarding the potential association of delirium with mortality in this context. 3,8,9,[13][14][15] There is therefore a need for further exploration of these issues.…”

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.…”

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte II: Mejorando la fonación para facilitar la comunicación

“…Respecto a las tareas de orientación y estimulación cognitiva, resulta muy relevante considerar que el delirium corresponde a una complicación que es común en las personas con COVID-19, siendo además marcador de un curso severo de la enfermedad, especialmente en aquellas adultas mayores y con comorbilidad neuropsiquiátrica (Kotfis et al, 2020;Ticinesi et al, 2020). El delirium, en el caso de esta población, se encuentra asociado principalmente a tres mecanismos de acción: la hipoxia derivada del SDRA, los efectos de los fármacos que permiten la sedación en personas con ventilación mecánica prolongada, y los procesos de inflamación sistémica, incluyendo estructuras cerebrales, que han sido descritos para esta enfermedad (Ramage, 2020).…”