Delirium in Critically Ill Patients with and without COVID-19—A Retrospective Analysis

Abstract

Background: Delirium complicating the course of Intensive care unit (ICU) therapy is a known driver of morbidity and mortality. It has been speculated that infection with the neurotrophic SARS-CoV-2 might promote delirium. Methods: Retrospective registry analysis including all patients treated at least 48 h on a medical intensive care unit. The primary endpoint was development of delirium as diagnosed by Nursing Delirium screening scale ≥2. Results were confirmed by propensity score matching. Results: 542 patients were included. The primary endpoint was reached in 352/542 (64.9%) patients, without significant differences between COVID-19 patients and non-COVID-19 patients (51.4% and 65.9%, respectively, p = 0.07) and correlated with prolonged ICU stay in both groups. In a subgroup of patients with ICU stay >10 days delirium was significantly lower in COVID-19 patients (p ≤ 0.01). After adjustment for confounders, COVID-19 correlated independently with less ICU delirium (p ≤ 0.01). In the propensity score matched cohort, patients with COVID-19 had significantly lower delirium incidence compared to the matched control patients (p ≤ 0.01). Conclusion: Delirium is frequent in critically ill patients with and without COVID-19 treated at an intensive care unit. Data suggests that COVID-19 itself is not a driver of delirium per se.

Delirium in hospitalized COVID-19 patients: Predictors and implications for patient outcome

“…We observed delirium in 22.8% across all hospitalized COVID-19 patients, and in 57.0% of the ICU-treated COVID-19 patients. Our study thus corroborates the results of previous studies that reported an overall incidence of delirium in 11%-33% of COVID-19 patients [ 9 , 11 ] and shows a higher incidence of delirium (more than 50%) for the intensive care setting [ 1 , 4 , 5 , 12 , 23 ]. Nevertheless, our study might even underestimate the incidence of delirium in the ICU, if one considers that some ICU patients were already transferred back to their referral hospitals before being weaned.…”

Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study

“…The increase in agitation or delirium in an imminently dying state during the pandemic in our study, which may indicate terminal delirium, is in line with results from a few studies of patients with COVID-19 or critically ill patients [ 16 - 18 ]. The ability of the virus to penetrate the central nervous system and influence neurons may make patients with COVID-19 susceptible to delirium [ 16 ].…”

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

“…Prolonged delirium can be interpreted as either a marker of a favorable evolution, or as the positive effect of strategies that minimize prolonged sedation on patient outcomes, such as daily sedation interruptions [31]. The incidence of delirium in this population was 25%, which is lower than what is reported in other COVID-19 studies [32]. While we did not record these data, we are aware of the many difficulties in adhering to delirium prevention strategies during the peaks of ICU admissions, such as daily sedation holds and reorientation through interactions with family members [31,33].…”

“…31 Neurosciences and Trauma Critical Care Unit (NCCU), Anaesthesia Medical Examiner and Clinical Lead Organ Donation-Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 32 Intensive Care Unit, Hospital Universitario de Torrejón, Madrid, Spain. 33 Universidad Francisco de Vitoria, Madrid, Spain.…”