Delirium Severely Worsens Outcome in Patients with COVID-19—A Retrospective Cohort Study from Temporary Critical Care Hospitals

Abstract

Delirium is a sign of deterioration of homeostasis and worse prognosis. The aim of this study was to investigate the frequency, risk factors and prognosis of delirium in patients with COVID-19 in a temporary acute setting hospital. A retrospective cohort analysis of data collected between October 2020 and February 2021 from two temporary acute care hospitals was performed. All consecutive hospitalized patients ≥18 years old with COVID-19 were included. An assessment of consciousness was carried out at least two times a day, including neurological examination. Delirium was identified through retrospective chart review according to DSM-5 criteria if present at least once during hospitalization. Analysis included 201 patients, 39 diagnosed with delirium (19.4%). Delirious patients were older (p < 0.001), frailer (p < 0.001) and the majority were male (p = 0.002). Respiratory parameters were worse in this group with higher oxygen flow (p = 0.013), lower PaO2 (p = 0.043) and higher FiO2 (p = 0.006). The mortality rate was significantly higher in patients with delirium (46.15% vs 3.70%, p < 0.001) with OR 17.212 (p < 0.001) corrected for age and gender. Delirious patients experienced significantly more complications: cardiovascular (OR 7.72, p < 0.001), pulmonary (OR 8.79, p < 0.001) or septic (OR 3.99, p = 0.029). The odds of mortality in patients with COVID-19 presenting with delirium at any point of hospitalization were seventeen times higher.

The Value of Clinical Frailty Scale (CFS) as a Prognostic Tool in Predicting Mortality in COVID-19—A Retrospective Cohort Study

“…The Charlson Comorbidity Index (CCI) was used and calculated using and on-line open-source calculator. Some results from analysis of this database regarding delirium in COVID-19 have already been published [6]. Patients were assessed using the CFS by medical doctors on admission, none of whom were geriatricians, trained according to the recent guidelines [7].…”

Risk Factors, Symptomatology, and Predictors of Mortality among COVID-19 Inpatients Presenting with Delirium Symptoms in a Tertiary Hospital in the Philippines

“…This is also consistent with available literature; other retrospective studies have found that the presence of delirium is a signi cant predictor of mortality. 7,19,22 Literature is not yet available to support the nding of patients with a combination of cardiac, endocrine, and renal comorbidities on past medical history having a lower risk for mortality. Having comorbidities has been found to be quite common among COVID-19 patients with delirium 7 .…”

“…To describe the risk factors, symptomatology, and predictors of mortality of con rmed COVID- 19 Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Odds ratio and the corresponding 95% con dence interval were derived from univariate logistic regression.…”

Clinical and Epidemiological Approach to Delirium in an Acute Care Unit: A Cross-Sectional Study

“…There could be a relationship between the administration of medication to control hyperactive ADE and subsequent hypoactivity, causing the mixed and alternate types of hyperactivity and hypoactivity, although in our case, we did not find a statistically significant relationship ( p = 0.09). Although there may be some conflict in the duration of therapy in the following days, its use is recommended for the shortest possible time and at the lowest possible dose [ 5 , 16 , 21 , 35 , 39 , 40 , 41 ].…”