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

Annabella Di Giorgio,Giuseppe Miscio,Pamela Raggi,Andrea Fontana,Maurizio A Leone,Massimo Carella,Carmen Marciano,Massimiliano Copetti,Filippo Aucella,Vincenzo Inchingolo,Michele Zarrelli,Clara De Gennaro,Antonio Greco,Paolo Emilio Alboini,Annibale Antonioni,Lucia Florio,Salvatore De Cosmo,Antonio Mirijello

doi:10.3390/diagnostics12020544

Abstract

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.

Highlights

Delirium is a neurocognitive disorder characterized by disturbance in attention and awareness that develops over a short period of time, fluctuates, and represents a change from the baseline behavioral state as a consequence of an underlying medical condition [1]
Two were the objectives of the present study: first, to evaluate the occurrence of delirium in a large cohort of adults hospitalized for COVID-19 and its impact on in-hospital mortality; second, to identify risk factors associated with delirium; in this regard, our attention was focused on inflammatory biomarkers
After adjustment for multiple comparisons, we found that only age, GCS, dementia, Charlson Index without dementia, pre-admission use of psychotropic drugs, C-reactive protein (CRP) and neutrophils-to-lymphocytes ratio (NLR) were associated with delirium in the univariable analysis

Summary

Introduction

Delirium is a neurocognitive disorder characterized by disturbance in attention and awareness that develops over a short period of time (hours, days), fluctuates, and represents a change from the baseline behavioral state as a consequence of an underlying medical condition [1]. Two were the objectives of the present study: first, to evaluate the occurrence of delirium in a large cohort of adults hospitalized for COVID-19 and its impact on in-hospital mortality; second, to identify risk factors associated with delirium; in this regard, our attention was focused on inflammatory biomarkers. These biomarkers are important, as immunopathology has been suggested as a primary driver of morbidity and mortality with COVID-19 [9]. 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. 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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Results

Discussion

Conclusion