Abstract
Objective: To examine any prospective association between neutrophil-to-lymphocyte ratio (NLR) at hospital admission and subsequent delirium in older COVID-19 hospitalized patients comparing by sex and age groups.Methods: The sample consisted of 1,785 COVID-19 adult inpatients (minimum sample size required of 635 participants) admitted to a public general hospital in Madrid (Spain) between March 16th and April 15th, 2020. Variables were obtained from electronic health records. Binary logistic regression models were performed between baseline NLR and delirium adjusting for age, sex, medical comorbidity, current illness severity, serious mental illness history and use of chloroquine and dexamethasone. An NLR cut-off was identified, and stratified analyses were performed by age and sex. Also, another biomarker was tested as an exposure (the systemic immune-inflammation index –SII).Results: 55.3% of the patients were men, with a mean age of 66.8 years. Roughly 13% of the patients had delirium during hospitalization. NLR on admission predicted subsequent delirium development (adjusted OR = 1.02, 95 percent CI: 1.00–1.04, p = 0.024). Patients between 69 and 80 years with NLR values > 6.3 presented a twofold increased risk for delirium (p = 0.004). There were no sex differences in the association between baseline NLR and delirium (p > 0.05) nor SII predicted delirium development (p = 0.341).Conclusion: NLR is a good predictor of delirium during hospitalization, especially among older adults, independently of medical comorbidity, illness severity, and other covariates. Routine blood tests on admission might provide valuable information to guide the decision-making process to be followed with these especially vulnerable patients.
Highlights
Delirium is an acute neuropsychiatric disorder with a fluctuating course that impairs consciousness, attention, and cognitive function (Inouye et al, 2014) and affects around 1 in 4 hospitalized patients (American Psychiatric Association [APA], 2013)
One out of three hospitalized COVID-19 patients endure neuropsychiatric manifestations during hospitalization (Nalleballe et al, 2020) which is associated with disease severity (Mao et al, 2020): two thirds of COVID-19 patients admitted to intensive care units (ICUs) experience agitation and half are diagnosed with delirium (Helms et al, 2020a)
This study aimed to explore any prospective association between Neutrophil-to-lymphocyte ratio (NLR) measured at hospital admission and subsequent development of delirium during hospitalization among COVID-19 patients
Summary
Delirium is an acute neuropsychiatric disorder with a fluctuating course that impairs consciousness, attention, and cognitive function (Inouye et al, 2014) and affects around 1 in 4 hospitalized patients (American Psychiatric Association [APA], 2013). Older adult patients among 62–82 years experiencing delirium during the intensive care unit (ICU) stay are at increased risk for cognitive dysfunction after hospital discharge (Pandharipande et al, 2013; Müller et al, 2020). One out of three hospitalized COVID-19 patients endure neuropsychiatric manifestations (e.g., headache, paresthesia, or disturbed consciousness) during hospitalization (Nalleballe et al, 2020) which is associated with disease severity (Mao et al, 2020): two thirds of COVID-19 patients admitted to intensive care units (ICUs) experience agitation and half are diagnosed with delirium (Helms et al, 2020a). Determinants of delirium among COVID-19 patients include systemic inflammation and neuroinflammation (following the cytokine storm driven by SARS-CoV-2 infection) (Fajgenbaum and June, 2020; Pensato et al, 2021; Perrin et al, 2021), organ dysfunction (e.g., respiratory or kidney failure), thrombosis, use of deep sedative strategies, prolonged mechanical ventilation, isolation (Ellul et al, 2020; Helms et al, 2020b; Kotfis et al, 2020) and specific medications for COVID-19 (Hamm and Rosenthal, 2020; Wu et al, 2021)
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