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

Abstract

for the CoViD-19 Lombardia Team OBJECTIVES: The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN: Multicenter observational cohort study. SETTINGS: Acute medical units in four Italian hospitals. PARTICIPANTS: A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS: Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS: Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION: Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.

Delirium symptoms duration and mortality in SARS-COV2 elderly: results of a multicenter retrospective cohort study

“…A recent review has reported how delirium affects up to 80% of the patients with SARS-COV2 in the ICU and between 29 and 67% in non-ICU patients [ 3 ]. Delirium in patients with SARS-COV2 is reported to increase the risk of mortality and worsen patients’ functional outcomes [ 11 , 12 ]. However, there are no information on the effect of delirium duration on patient’s health status.…”

Profiling Delirium Progression in Elderly Patients via Continuous-Time Markov Multi-State Transition Models

“…In literature, delirium outcome has been mainly addressed in prevalence [ 15 , 16 , 17 ] and incidence studies [ 18 ]. These approaches are useful to investigate the magnitude of the problem in a specific ward and moment.…”

“…Delirium has also been considered a factor influencing the risk of developing other new forms of dementia [ 23 ] and as a possible issue affecting the quality of life [ 24 ]. In these research studies, the statistical methods mostly used are linear regression [ 16 ] or Cox proportional hazard model (shortly Cox model) [ 16 , 21 , 22 ]. Such methods are relevant for understanding the problem of delirium and its consequences in terms of clinical outcomes.…”

Delirium in Covid-19 patients: Incidence, Risk Factors and Early Outcomes.

“…Parkinson's disease was present in only two patients; both of them developed delirium during hospitalization. Other authors have reported delirium in patients with dementia (27,28), in smokers (15) or in patients with a higher number of comorbidities (31). In our cohort only seven patients had a baseline cognitive de cit.…”