Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study

Abstract

Purpose The occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP). Patients and Methods This cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses. Results A total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74–88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01–1.85) for every 50 mg/L increase. Conclusion In this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.

A importância do diagnóstico precoce do delirium em pacientes idosos com Covid-19

“…Pacientes com comprometimento cognitivo apresentaram maior chances de desenvolver o delirium comparado aos que eram cognitivamente normais antes de contrair a doença. Outra observação feita através dos estudos é que a maioria dos casos de delirium ocorreram no primeiro dia de internação, o que comprova e salienta a importância do cuidado integral desde o aparecimento dos primeiros sintomas (Forget et al, 2021;Mendes et al, 2021). vulnerável de pacientes é facilitada, fazendo com que a prestação de cuidados ocorra da maneira mais adequada possível (Alkeridy et al, 2020;Hariyanto et al, 2021;Mattace-Raso et al, 2020;Pranata et al, 2021;Zazzara et al, 2021).…”

Risk factors and outcomes of delirium in hospitalized older adults with COVID-19: A systematic review and meta-analysis

“…[ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]…”

Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization

“… 3 Delirium is a common presentation (30%-45%) in older adults hospitalized for infection such as influenza, pneumonia, urinary tract infection, and COVID-19. 4 , 5 , 6 Although antipsychotic medications (APMs) are commonly prescribed to manage behavioral disturbances caused by delirium, these agents are associated with multiple serious adverse clinical outcomes, including death, cardiac arrhythmia, orthostatic hypotension, pneumonia, and urinary dysfunction. 7 , 8 , 9 Therefore, clinical consensus recommends that APMs should be used with caution in older adults and should be discontinued as soon as possible.…”