Delirium is a good predictor for poor outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review, meta-analysis, and meta-regression

Hariyanto, Timotius Ivan; Putri, Cynthia; Hananto, Joshua Edward; Arisa, Jessie; Situmeang, Rocksy Fransisca V.; Kurniawan, Andree

doi:10.1016/j.jpsychires.2021.08.031

Cited by 32 publications

(28 citation statements)

References 53 publications

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“…Indeed, delirium is a common complication in patients with COVID-19 and has been shown to be associated with an increased risk of mortality in these patients [ 8 – 10 ]. While the neurological and psychological complications associated with coronavirus disease 19 (COVID-19) are well recognized [ 11 ], many studies investigating the impact of COVID-19 on delirium frequency have centered on ICU populations [ 10 , 12 ] or do not clearly state the criteria for delirium diagnosis [ 9 ]. This study sought to identify the association between COVID-19 severity or age with the presence of delirium in hospitalized adults using a systematic in person delirium screening program.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study

et al. 2022

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Background Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay. Methods In this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols. Results A total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those < 45 years old (aOR 8.7; 95% CI 2.2, 33.5; P = 0.003). Delirium was associated with increased odds of safety attendant use (aOR 4.5; 95% CI 1.0, 20.7; P = 0.050), decreased odds of discharge home (aOR 0.2; 95% CI 0.06, 0.6; P = 0.005), and increased length of stay (aOR 7.5; 95% CI 2.0, 13; P = 0.008). Conclusions While delirium is common in hospitalized patients of all ages with COVID-19, it is especially common in those with severe disease on hospital admission and those who are older. Patients with COVID-19 and delirium, compared to COVID-19 without delirium, are more likely to require safety attendants during hospitalization, less likely to be discharged home, and have a longer length of stay. Individuals with COVID-19, including younger patients, represent an important population to target for delirium screening and management as delirium is associated with important differences in both clinical care and disposition.

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Section: Introductionmentioning

confidence: 99%

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study

et al. 2022

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“…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.…”

Section: Discussionmentioning

confidence: 89%

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

Lidou-Renault

Baudouin

Courtois-Amiot

et al. 2022

The Journals of Gerontology: Series A

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Background Few data are available on the prognosis of older patients who received corticosteroids for COVID-19. We aimed to compare the in-hospital mortality of geriatric patients hospitalized for COVID-19 who received corticosteroids or not. Methods We conducted a multicentric retrospective cohort study in 15 acute COVID-19 geriatric wards in the Paris area from March to April 2020 and November 2020 to May 2021. We included all consecutive patients aged 70 years and older who were hospitalized with confirmed COVID-19 in these wards. Propensity score and multivariate analyses were used. Results Of the 1579 patients included (535 received corticosteroids), the median age was 86 (interquartile range 81-91)years, 56% of patients were female, the median Charlson Comorbidity Index (CCI) was 2.6 (interquartile range 1-4), and 64% of patients were frail (Clinical Frailty Score 5-9). The propensity score analysis paired 984 patients (492 with and without corticosteroids). The in-hospital mortality was 32.3% in the matched cohort. On multivariate analysis, the probability of in-hospital mortality was increased with corticosteroids use (odds ratio [OR]=2.61 [95% confidence interval (CI) 1.63-4.20]). Other factors associated with in-hospital mortality were age (OR=1.04[1.01-1.07], CCI (OR=1.18[1.07-1.29], activities of daily living (OR=0.85[0.75-0.95], oxygen saturation <90% on room air (OR=2.15[1.45-3.17], C-reactive protein level (OR=2.06[1.69-2.51] and lowest lymphocyte count (OR=0.49[0.38-0.63]). Among the 535 patients who received corticosteroids, 68.3% had at least one corticosteroid side effect, including delirium(32.9%), secondary infections(32.7%) and decompensated diabetes(14.4%). Conclusions In this multicentric matched-cohort study of geriatric patients hospitalized for COVID-19, the use of corticosteroids was significantly associated with in-hospital mortality.

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“… 16 Our multicenter findings are comparable. Delirium has been identified as an independent risk factor for severe disease 16 , 35 and death 16 , 35 and should be considered an important marker to identify patients at risk of developing poor COVID‐19 outcomes. Patients with dementia more often present with delirium and should therefore be considered a particularly high risk population.…”

Section: Discussionmentioning

confidence: 99%

Age‐related differences in symptoms in older emergency department patients with COVID‐19: Prevalence and outcomes in a multicenter cohort

Goldberg

Southerland

Meltzer³

et al. 2022

J American Geriatrics Society

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Background Older adults represent a disproportionate share of severe COVID‐19 presentations and fatalities, but we have limited understanding of the differences in presentation by age and the association between less typical emergency department (ED) presentations and clinical outcomes. Methods This retrospective cohort study used the RECOVER Network registry, a research collaboration of 86 EDs in 27 U.S. states. We focused on encounters with a positive nasopharyngeal swab for SARS‐CoV‐2, and described their demographics, clinical presentation, and outcomes. Sequential multivariable logistic regressions examined the strength of association between age cohort and outcomes. Results Of 4536 encounters, median patient age was 55 years, 49% were women, and 34% were non‐Hispanic Black persons. Cough was the most common presenting complaint across age groups (18–64, 65–74, and 75+): 71%, 67%, and 59%, respectively ( p < 0.001). Neurological symptoms, particularly altered mental status, were more common in older adults (2%, 11%, 26%; p < 0.001). Patients 75+ had the greatest odds of ED index visit admission of all age groups (adjusted odds ratio [aOR] 6.66; 95% CI 5.23–8.56), 30‐day hospitalization (aOR 7.44; 95% CI 5.63–9.99), and severe COVID‐19 (aOR 4.26; 95% CI 3.45–5.27). Compared to individuals with alternate presentations and adjusting for age, patients with typical symptoms (fever, cough and/or shortness of breath) had similar odds of ED index visit admission (aOR 1.01; 95% CI 0.81–1.24), potentially higher odds of 30‐day hospitalization (aOR 1.23; 95% CI 1.00–1.53), and greater odds of severe COVID‐19 (aOR 1.46; 95% CI 1.12–1.90). Conclusions Older patients with COVID‐19 are more likely to have presentations without the most common symptoms. However, alternate presentations of COVID‐19 in older ED patients are not associated with greater odds of mechanical ventilation and/or death. Our data highlights the importance of a liberal COVID‐19 testing strategy among older ED patients to facilitate accurate diagnoses and timely treatment and prophylaxis.

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Delirium is a good predictor for poor outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review, meta-analysis, and meta-regression

Cited by 32 publications

References 53 publications

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study

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

Age‐related differences in symptoms in older emergency department patients with COVID‐19: Prevalence and outcomes in a multicenter cohort

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