Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study

Saini, Aman; Oh, Tae-Hyun; Ghanem, Dory Anthony; Castro, Megan; Butler, Matthew; Lam, Chun Chiang Sin Fai; Posporelis, Sotiris; David, Anthony S.; Rogers, Jonathan

doi:10.1080/13607863.2021.1989375

Cited by 2 publications

(2 citation statements)

References 71 publications

(72 reference statements)

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“…Additionally, comorbidity was removed from the final model because of collinearity with age and dementia. This result is consistent with previous evidence in the non-COVID-19 literature, which indicates that CRP independently predicts delirium [ 25 , 26 , 27 ], and with recent findings in COVID-19 patients suggesting an association between CRP levels and delirium occurrence [ 28 ]. The possible pathophysiologic mechanisms (direct invasion of the brain, brain hypoxia due to systemic hypoxemia or coagulopathy, cytokine storm and neuroinvasion) [ 29 , 30 , 31 ] that contribute to the occurrence of delirium among COVID-19 patients, and their mutual interaction, are still unclear.…”

Section: Discussionsupporting

confidence: 93%

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

et al. 2022

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Background: A significant proportion of patients with coronavirus disease 2019 (COVID-19) suffer from delirium during hospitalization. This single-center observational study investigates the occurrence of delirium, the associated risk factors and its impact on in-hospital mortality in an Italian cohort of COVID 19 inpatients. Methods: Data were collected in the COVID units of a general medical hospital in the South of Italy. Socio-demographic, clinical and pharmacological features were collected. Diagnosis of delirium was based on a two-step approach according to 4AT criteria and DSM5 criteria. Outcomes were: dates of hospital discharge, Intensive Care Unit (ICU) admission, or death, whichever came first. Univariable and multivariable proportional hazards Cox regression models were estimated, and risks were reported as hazard ratios (HR) along with their 95% confidence intervals (95% CI). Results: A total of 47/214 patients (22%) were diagnosed with delirium (21 hypoactive, 15 hyperactive, and 11 mixed). In the multivariable model, four independent variables were independently associated with the presence of delirium: dementia, followed by age at admission, C-reactive protein (CRP), and Glasgow Coma Scale. In turn, delirium was the strongest independent predictor of death/admission to ICU (composite outcome), followed by Charlson Index (not including dementia), CRP, and neutrophil-to-lymphocyte ratio. The probability of reaching the composite outcome was higher for patients with the hypoactive subtype than for those with the hyperactive subtype. Conclusions: Delirium was the strongest predictor of poor outcome in COVID-19 patients, especially in the hypoactive subtype. Several clinical features and inflammatory markers were associated with the increased risk of its occurrence. The early recognition of these factors may help clinicians to select patients who would benefit from both non-pharmacological and pharmacological interventions in order to prevent delirium, and in turn, reduce the risk of admission to ICU or death.

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Section: Discussionsupporting

confidence: 93%

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

et al. 2022

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“…The presented results confirm the effect of generalized inflammation caused by COVID-19 on the functioning of numerous organs, including the central nervous system, which gives clinical symptoms in the form of delirium [52].…”

Section: Discussionsupporting

confidence: 78%

ICU Delirium Is Associated with Cardiovascular Burden and Higher Mortality in Patients with Severe COVID-19 Pneumonia

Gutowski¹,

Klimkiewicz²,

Michałowski³

et al. 2023

JCM

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Background: COVID-19 can lead to functional disorders and complications, e.g., pulmonary, thromboembolic, and neurological. The neuro-invasive potential of SARS-CoV-2 may result in acute brain malfunction, which manifests as delirium as a symptom. Delirium is a risk factor for death among patients hospitalized due to critical illness. Taking the above into consideration, the authors investigated risk factors for delirium in COVID-19 patients and its influence on outcomes. Methods: A total of 335 patients hospitalized due to severe forms of COVID-19 were enrolled in the study. Data were collected from medical charts. Results: Delirium occurred among 21.5% of patients. In the delirium group, mortality was significantly higher compared to non-delirium patients (59.7% vs. 28.5%; p < 0.001). Delirium increased the risk of death, with an OR of 3.71 (95% CI 2.16–6.89; p < 0.001). Age, chronic atrial fibrillation, elevated INR, urea, and procalcitonin, as well as decreased phosphates, appeared to be the independent risk factors for delirium occurrence. Conclusions: Delirium occurrence in patients with severe COVID-19 significantly increases the risk of death and is associated with a cardiovascular burden. Hypophosphatemia is a promising reversible factor to reduce mortality in this group of patients. However, larger studies are essential in this area.

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Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study

Cited by 2 publications

References 71 publications

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

ICU Delirium Is Associated with Cardiovascular Burden and Higher Mortality in Patients with Severe COVID-19 Pneumonia

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