Delirium in older COVID‐19 patients: Evaluating risk factors and outcomes

Kroon, Bart; Beishuizen, Sara J.; Rensen, Inge H.T. van; Barten, Dennis G.; Mehagnoul‐Schipper, Jannet J.; Bol, Jessica M. van der; Ellerbroek, Jacobien; Festen, J.; Glind, Esther M.M. van de; Hempenius, Liesbeth; Jagt, Mathieu van der; Jansen, Steffy W.; Linden, Carolien J.M. van der; Mooijaart, Simon P.; Munster, Barbara C. Van; Oosterwijk, Leanne L.E.; Smit, Lisa; Urlings‐Strop, Louise C.; Willems, Hanna C.; Mattace‐Raso, Francesco; Polinder-Bos, Harmke A

doi:10.1002/gps.5810

Cited by 13 publications

(15 citation statements)

References 48 publications

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“…Further factors previously reported to increase the likelihood of delirium in COVID-19, but not assessed in our study, comprise frailty, alcoholism, smoking, and polypharmacy [ 9 , 10 , 29 ]. For instance, it has been previously shown that delirium does not represent an independent predictor of mortality in frail patients with COVID-19 [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Introduction Delirium is recognized as a severe complication of coronavirus-disease-2019 (COVID-19). COVID-19-associated delirium has been linked to worse patient outcomes and is considered to be of multifactorial origin. Here we sought to evaluate the incidence and risk factors of delirium in hospitalized COVID-19 patients, along with its impact on clinical outcome. Methods Consecutive adult COVID-19 patients admitted to a tertiary academic referral hospital between March 1st and December 31st, 2020 were included. Potential risk factors for delirium were evaluated, including: age, gender, disease severity (as per the highest WHO grading reached during admission), laboratory parameters for infection and renal function (as per their most extreme values), and presence of comorbidities. To assess the relative strength of risk factors for predicting the occurrence of delirium, we performed a random-forest survival analysis. Results 347 patients with positive COVID-19 PCR test and median age 68.2 [IQR 55.5, 80.5] years were included. Of those, 79 patients (22.8%) developed delirium, 81 (23.3%) were transferred to ICU, 58 (16.7%) died. 163 (73.8%) patients were discharged home, 13 (5.9%) to another hospital, 32 (14.5%) to nursing homes, 13 (5.9%) to rehabilitation with an overall median admission-to-discharge time of 53 [IQR 14, 195] days. The strongest predictors for the occurrence of delirium were blood urea nitrogen (minimal depth value (MD): 3.33), age (MD: 3.75), disease severity (as captured by WHO grading; MD: 3.93), leukocyte count (MD: 4.22), the presence of a neurodegenerative history (MD: 4.43), ferritin (MD: 4.46) and creatinine (MD: 4.59) levels. Conclusion The risk of delirium in COVID-19 can be stratified based on COVID-19 disease severity and–similar to delirium associated with other respiratory infections–the factors advanced age, neurodegenerative disease history, and presence of elevated infection and renal-retention parameters. Screening for these risk factors may facilitate early identification of patients at high-risk for COVID-19-associated delirium.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…An additional finding of our study is that having COVID-19 and delirium was significantly associated with increased LOS as compared with COVID-19 alone. The relationship between delirium and LOS has been evaluated in other studies, which have demonstrated that the LOS was longer in patients with a COVID-19 diagnosis who developed delirium,20,21,25 with one study demonstrating a median LOS approximately 1.5 times greater21 and a second study demonstrating no change 26…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated a positive association with in-hospital mortality among older patients with COVID-19. 20,[22][23][24][25][26][27] However, other studies looking specifically at mortality in patients with delirium have shown mixed results. Ticinesi and colleagues 27 demonstrated significantly higher mortality in patients who developed delirium during hospitalization than those who did not (57% vs 30%, P < .001), while another reported delirium was not associated with higher mortality.…”

Section: Delirium and In-hospital Mortalitymentioning

confidence: 99%

Delirium in the Era of COVID-19

Byrnes

Pate

Cochran

et al. 2023

Journal of Nursing Care Quality

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Background: Delirium has been associated with poor outcomes in hospitalized older adults. Rates of delirium have increased in the context of coronavirus disease 2019 (COVID-19). Purpose: To explore the prevalence of delirium in older adult patients hospitalized with COVID-19 as well as correlations with age, gender, length of stay (LOS), occurrence of an intensive care unit admission or transfer, and in-hospital mortality in 2 hospitals in the southeast United States. Methods: A retrospective study of 1502 patients admitted between 2020 and 2021 was completed. Results: Older adult patients hospitalized with delirium and COVID-19 demonstrated significantly prolonged LOS (14.1 days vs 7.1 days, P < .0001) and higher rates of in-hospital mortality (33.5% vs 12.8%, P < .0001). Conclusions: Findings of this study add to the growing literature on delirium in hospitalized patients and support the need for future initiatives to create protocols for monitoring and nursing care management of delirium to improve care delivery.

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“…It mainly affects frail older adults and severely ill patients and is associated with increased risk on adverse clinical outcomes 2 . Delirium also plays a significant role in the context of older patients hospitalised for Coronavirus disease 2019 (COVID‐19) and its estimated prevalence is between 14.2% and 54.9% 3,4 . Severe Acute Respiratory Syndrome Coronovirus‐2 (SARS‐CoV‐2) can induce the onset of metabolic encephalopathy in patients with COVID‐19 by a cytokine storm, hypoxemia and the direct effect on the central nervous system 5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…2 Delirium also plays a significant role in the context of older patients hospitalised for Coronavirus disease 2019 (COVID- 19) and its estimated prevalence is between 14.2% and 54.9%. 3,4 Severe Acute Respiratory Syndrome Coronovirus-2 (SARS-CoV-2) can induce the onset of metabolic encephalopathy in patients with COVID-19 by a cytokine storm, hypoxemia and the direct effect on the central nervous system. 5,6 Delirium during COVID-19 hospitalisation poses several specific challenges.…”

Section: Introductionmentioning

confidence: 99%

Delirium in older patients with COVID‐19: Prevalence, risk factors and clinical outcomes across the first three waves of the pandemic

Minnema,

Tap,

van der Bol

et al. 2023

Int J Geriat Psychiatry

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ObjectivesDelirium is a serious condition, which poses treatment challenges during hospitalisation for COVID‐19. Improvements in testing, vaccination and treatment might have changed patient characteristics and outcomes through the pandemic. We evaluated whether the prevalence and risk factors for delirium, and the association of delirium with in‐hospital mortality changed through the pandemic.MethodsThis study was part of the COVID‐OLD study in 19 Dutch hospitals including patients ≥70 years in the first (spring 2020), second (autumn 2020) and third wave (autumn 2021). Multivariable logistic regression models were used to study risk factors for delirium, and in‐hospital mortality. Differences in effect sizes between waves were studied by including interaction terms between wave and risk factor in logistic regression models.Results1540, 884 and 370 patients were included in the first, second and third wave, respectively. Prevalence of delirium in the third wave (12.7%) was significantly lower compared to the first (22.5%) and second wave (23.5%). In multivariable‐adjusted analyses, pre‐existing memory problems was a consistent risk factor for delirium across waves. Previous delirium was a risk factor for delirium in the first wave (OR 4.02), but not in the second (OR 1.61) and third wave (OR 2.59, p‐value interaction‐term 0.028). In multivariable‐adjusted analyses, delirium was not associated with in‐hospital mortality in all waves.ConclusionDelirium prevalence declined in the third wave, which might be the result of vaccination and improved treatment strategies. Risk factors for delirium remained consistent across waves, although some attenuation was seen in the second wave.

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Delirium in older COVID‐19 patients: Evaluating risk factors and outcomes

Cited by 13 publications

References 48 publications

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

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

Delirium in the Era of COVID-19

Delirium in older patients with COVID‐19: Prevalence, risk factors and clinical outcomes across the first three waves of the pandemic

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