Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

Abstract

Delirium is an acute confusional state characterized by altered level of consciousness and attention. Coronavirus Disease 2019 , caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), can manifest itself with this neuropsychiatric disorder. The endpoints of our study were: the frequency of delirium in subjects with COVID-19 pneumonia; the risk factors that predispose to this condition; and the impact of delirium on mortality. Subjects were consecutively enrolled in a Geriatric Unit from January 5th to March 5th, 2021. Inclusion criteria were: diagnosis of SARS-CoV-2 infection, a radiologically documented pneumonia, and the ability of providing informed consent. Exclusion criteria were: absence of radiological evidence of pneumonia, sepsis, and the need of intensive care unit treatment. All subjects were evaluated by means of Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at least twice per day. In the study cohort (n = 71), twenty patients (28.2%) had delirium. Delirium was present on admission in 11.3%, and occurred during hospitalization in 19.0%. Compared to patients without delirium, patients who developed this neuropsychiatric disorder had a higher mortality rate (35% vs 5.9%) and an increased average hospital length of stay (21 days vs 17 days). In the multivariate analysis delirium was associated with frailty (OR = 2.81; CI = 1.4-5.8) and helmet ventilation (OR = 141.05; CI = 4.3-4663.9). Delirium was an independent predictor of mortality. Nearly a third of subjects (28.2%) had delirium during hospitalization for COVID-19. This finding supports the notion that delirium is a common complication of SARS-CoV2 infection. Since delirium is associated with longer hospital stay, and it is an independent marker of increased mortality, clinicians should assess and prevent it.

Delirium in older COVID‐19 patients: Evaluating risk factors and outcomes

“…First, in two cohorts, a CFS >5 was associated with increased delirium risk. 10,22 Second, in a large multicenter study, increased CFS was not associated with incident 19 However, differences in study population, covariates included and CFS cut-off values used make these results not directly comparable to our findings. Our results emphasize that, in addition to frailty, it is important to assess cognitive impairment and the occurrence of a prior delirious episode to establish delirium risk in COVID-19 patients.…”

“…Few previous studies investigated the impact of frailty together with other predisposing risk factors on delirium prevalence in COVID‐19 patients. First, in two cohorts, a CFS >5 was associated with increased delirium risk 10,22 . Second, in a large multicenter study, increased CFS was not associated with incident delirium 19 .…”

“…20 Whether delirium and frailty are both independent predictors of mortality, or if frailty explains the association of delirium with mortality is debatable. Conflicting findings have been reported, suggesting that delirium predicts mortality independent from frailty, [21][22][23] and studies that suggest no association of delirium with mortality. 19,24 The aim of this study was to investigate whether traditional predisposing determinants and the CFS are associated with delirium in older COVID-19 patients admitted and hospitalized at the general ward.…”

“…Whether delirium and frailty are both independent predictors of mortality, or if frailty explains the association of delirium with mortality is debatable. Conflicting findings have been reported, suggesting that delirium predicts mortality independent from frailty, 21–23 and studies that suggest no association of delirium with mortality 19,24 …”

Delirium in COVID‑19 pneumonia: looking inside the geriatric unit

“…We read with great interest this interesting article where the existence of delirium in sufferers of COVID-19 pneumonia in a geriatric intensive care unit was studied [ 1 ]. We congratulate the authors on their work in this emerging area of importance, and raise several points we feel warrant further discussion.…”