Delirium in hospitalized COVID-19 patients: Predictors and implications for patient outcome

Abstract

Introduction Delirium is recognized as a severe complication of coronavirus-disease-2019 (COVID-19). COVID-19-associated delirium has been linked to worse patient outcomes and is considered to be of multifactorial origin. Here we sought to evaluate the incidence and risk factors of delirium in hospitalized COVID-19 patients, along with its impact on clinical outcome. Methods Consecutive adult COVID-19 patients admitted to a tertiary academic referral hospital between March 1st and December 31st, 2020 were included. Potential risk factors for delirium were evaluated, including: age, gender, disease severity (as per the highest WHO grading reached during admission), laboratory parameters for infection and renal function (as per their most extreme values), and presence of comorbidities. To assess the relative strength of risk factors for predicting the occurrence of delirium, we performed a random-forest survival analysis. Results 347 patients with positive COVID-19 PCR test and median age 68.2 [IQR 55.5, 80.5] years were included. Of those, 79 patients (22.8%) developed delirium, 81 (23.3%) were transferred to ICU, 58 (16.7%) died. 163 (73.8%) patients were discharged home, 13 (5.9%) to another hospital, 32 (14.5%) to nursing homes, 13 (5.9%) to rehabilitation with an overall median admission-to-discharge time of 53 [IQR 14, 195] days. The strongest predictors for the occurrence of delirium were blood urea nitrogen (minimal depth value (MD): 3.33), age (MD: 3.75), disease severity (as captured by WHO grading; MD: 3.93), leukocyte count (MD: 4.22), the presence of a neurodegenerative history (MD: 4.43), ferritin (MD: 4.46) and creatinine (MD: 4.59) levels. Conclusion The risk of delirium in COVID-19 can be stratified based on COVID-19 disease severity and–similar to delirium associated with other respiratory infections–the factors advanced age, neurodegenerative disease history, and presence of elevated infection and renal-retention parameters. Screening for these risk factors may facilitate early identification of patients at high-risk for COVID-19-associated delirium.

Delirium in patients with COVID-19 treated in the intensive care unit

“…Delirium is associated with an increased duration of hospitalization, including ICU stay, and with increased complication and mortality rates in critically ill patients [21][22][23][24][25][26][27][28][29]. Delirium…”

High-dose glucocorticoids in COVID-19 patients with acute encephalopathy: clinical and imaging findings in a retrospective cohort study

“…During the pandemic, acute encephalopathy (AE), in its most frequent clinical manifestation, delirium, affected up to 65% of hospitalized patients with COVID-19 (Helms et al 2020 ) and was associated with a higher mortality (Mendes et al 2021 ). The risk of developing delirium in COVID-19 was greater in older patients, in presence of a more severe form of the disease, and of a preexisting cognitive impairment (Wilke et al 2022 ; Damanti et al 2023 ). Several factors likely contribute to AE pathogenesis in COVID-19, with suggested mechanisms including exposure to intensive care unit procedures, a prothrombotic, microvascular dysfunction, and proinflammatory state (Pensato et al 2021 ).…”

Outcomes of COVID-19-Associated Hospitalizations in Geriatric Patients with Dementia in the United States: A Propensity Score Matched Analysis

“…Factors such as age, comorbidities, cognitive decline, and communication challenges amplify their susceptibility to COVID-19. Moreover, the pandemic can worsen cognitive symptoms, increase delirium risks, and intensify feelings of social isolation, further undermining their mental and physical health [ 3 , 4 , 7 ].…”

“…The intersecting challenges of COVID-19 and dementia present a global dilemma that requires careful consideration by healthcare professionals, caregivers, and policymakers [ 7 ]. Deepening our understanding of how COVID-19 affects dementia patients is crucial, and such insights are pivotal when shaping clinical strategies and developing effective, patient-centered care paradigms [ 9 ].…”