Delirium in COVID-19 patients: a multicentric observational study in Italy

Abstract

Introduction Although recent data show that SARS-CoV-2 infection seems to affect the central nervous system (CNS), little is known about the neuropsychiatric effects resulting from this condition. In addition to the well-known neurotrophism of coronaviruses, recent evidence shows also that the “cytokine storm” induced by the infection is at the basis of the neuroinflammation of the CNS. Furthermore, prolonged hospitalization, polypharmacotherapy, and isolation could be at the basis of the onset of delirium in hospitalized COVID patients. This multicentric observational study explores the incidence of the onset of delirium in an Italian cohort of SARS-CoV-2 positive inpatients. Methods Data were collected in the COVIDhospitals of Brescia, Bergamo, Chieti, and Genova. Different socio-demographic, medical, neurological, and pharmacological parameters were collected. As a rapid screening for delirium, the 4AT scale was used. Eighty COVID-19 inpatients (mean age 74.7 ± 14.5 years) met the inclusion criteria (confirmed positivity to the SARS-CoV-2 virus; the presence of delirium and/or psychomotor agitation and/or new onset of other neuropsychiatric symptoms during hospitalization). Results The majority of these patients (68.8%) had “hyperactive delirium” subtype. Polypharmacotherapy, current treatment with corticosteroids, and higher age were associated with delirium severity. Conclusion These data provide an insight into the onset of delirium among COVID-19 patients underlining the need for monitoring, especially in elderly patients, the neuropsychiatric symptoms, and the therapy in order to have shorter hospitalization times and better outcomes.

Frequency of delirium and its associated factors among COVID‐19 inpatients in Iran

“…While in the present study, the frequency of delirium in 309 patients with confirmed COVID‐19 was determined. In addition, the measurement tool of that study for delirium was the 4 ‘A's Test, which only takes a few minutes, but in the present study, more reliable tools were used 28 . Moreover, another retrospective study was conducted in elderly patients with COVID‐19 in London, and the frequency of delirium in that population was 23.9%.…”

“…In addition, the measurement tool of that study for delirium was the 4 'A's Test, which only takes a few minutes, but in the present study, more reliable tools were used. 28 Moreover, another retrospective study was conducted in elderly patients with COVID-19 in London, and the frequency of delirium in that population was 23.9%. In the limitations of their study, the authors mentioned that the retrospective nature makes the data interpretation to be done with caution.…”

Corticosteroid Therapy in COVID-19 Associated With In-hospital Mortality in Geriatric Patients: A Propensity Matched Cohort Study

“…Although the study design did not allow for a comparison with patients without corticosteroids, this prevalence appears important. Delirium, the most frequent complication reported in our cohort, is known to be associated with mortality in COVID-19 ( 37 ) and the severity of delirium increases with age and corticosteroid use ( 38 ). Secondary infections were reported in 7% of patients hospitalized for COVID-19 ( 39 ) but concerned 32.7% of our patients who received corticosteroids.…”

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

“…Após a análise dos resultados (Tabela 1), confirma-se que são fatores de risco não modificáveis para o delirium: sexo masculino, ser idoso, o número total de medicamentos em uso e uso de antipsicóticos, além de possuir demência e/ou deficiência auditiva, visual e funcional. Também pode estar associado a resultados clínicos ruins, incluindo a permanência hospitalar prolongada, admissão em institutos de longa permanência, necessidade de terapia intensiva, o uso de ventilação mecânica e a perda de independência (García-Grimshaw et al, 2020;Mcloughlin et al, 2020;Mattace-Raso et al, 2020;Duggan;Martinotti et al 2021).…”