The impact of delirium on outcomes for older adults hospitalised with COVID-19

Abstract

Introduction: Delirium is a frequent condition in hospitalized older patients and it usually has a negative prognostic value. A direct effect of SARS-COV-2 on the central nervous system (CNS) has been hypothesized. Objective: To evaluate the presence of delirium in older patients admitted for a suspected diagnosis of COVID-19 and its impact on in-hospital mortality. Setting and subjects: 91 patients, aged 70-years and older, admitted to an acute geriatric ward in Northern Italy from March 8th to April 17th, 2020. Methods: COVID-19 cases were confirmed by reverse transcriptase-polymerase chain reaction assay for SARS-Cov-2 RNA from nasal and pharyngeal swabs. Delirium was diagnosed by two geriatricians according to the DSM-V criteria. The number of chronic diseases was calculated among a pre-defined list of 60. The pre-disease Clinical Frailty Scale (CFS) was assessed at hospital admission. Results: Of the total sample, 39 patients died, 49 were discharged and 3 were transferred to ICU. Twenty-five patients (27.5%) had delirium. Seventy-two percent of patients with delirium died during hospitalization compared to 31.8% of those without delirium. In a multivariate logistic regression model adjusted for potential confounders, patients with delirium were four times more likely to die during hospital stay compared to those without delirium (OR = 3.98;95%CI = 1.05–17.28; p = 0.047). Conclusions: Delirium is common in older patients with COVID-19 and strongly associated with in-hospital mortality. Regardless of causation, either due to a direct effect of SARS-COV-2 on the CNS or to a multifactorial cause, delirium should be interpreted as an alarming prognostic indicator in older people.

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

“…Our results are, instead, in keeping with those of Mao et al, 25 who found a 14.8% prevalence of impaired consciousness, and Garcez et al, 14 who reported a 12% prevalence of delirium on hospital admission. However, when our analyses excluded the data from Center 3, which diagnosed delirium exclusively on the basis of physician clinical impression, our results concur with those of three recent studies that found delirium prevalence rates of around 25% 10,12,13 …”

“…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.…”

“…[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.…”

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

“…Delirium on admission has been previously identified as a predictor for mortality in patients with COVID-19 [ 42 , 43 ]; a 59% mortality rate was also documented among patients who experienced delirium on admission at our hospital. However, after multivariate analysis, delirium was found not to independently determine mortality, most likely due to the fact that it involves acute failure of brain processes and is strongly related to hypoxemia in critical ill patients.…”

Delirium: Clinical Presentation and Outcomes in Older COVID-19 Patients

“…The overall prevalence of delirium in the hospital setting is about 14-24%; its prevalence is higher, about 30%, in emergency, surgical, or medical wards (3,4). To date, the clinical presentation of delirium in older patients with COVID-19 infection have rarely been described; in fact, although some studies focus on epidemiological data and outcome, few studies analyze the clinical aspects of delirium in COVID-19 (5)(6)(7)(8). The aim of this study is to describe clinical characteristics and outcomes of a series of elderly patients presenting delirium as the main symptom of COVID-19.…”