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Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study
Annabella Di Giorgio1, Antonio Mirijello2, Clara De Gennaro1
1Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
Insights
Delirium is a strong predictor of poor outcomes in COVID-19 patients, particularly the hypoactive subtype. Early recognition of risk factors like dementia and inflammation can guide interventions to prevent delirium and reduce mortality or ICU admission.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Neurology
Background:
- A significant proportion of hospitalized coronavirus disease 2019 (COVID-19) patients develop delirium.
- This study investigates delirium occurrence, risk factors, and impact on mortality in Italian COVID-19 inpatients.
Purpose of the Study:
- To determine the incidence of delirium in COVID-19 patients.
- To identify risk factors associated with delirium development.
- To assess the impact of delirium on in-hospital mortality and Intensive Care Unit (ICU) admission.
Main Methods:
- Single-center observational study in COVID-19 units.
- Delirium diagnosed using 4AT and DSM-5 criteria.
- Cox regression models analyzed risk factors and outcomes (death/ICU admission).
Main Results:
- 22% of patients (47/214) were diagnosed with delirium (hypoactive, hyperactive, or mixed).
- Independent predictors of delirium included dementia, age, C-reactive protein (CRP), and Glasgow Coma Scale.
- Delirium was the strongest predictor of death/ICU admission, followed by Charlson Index, CRP, and neutrophil-to-lymphocyte ratio.
Conclusions:
- Delirium, especially the hypoactive subtype, is the strongest predictor of poor outcomes in COVID-19 patients.
- Clinical features and inflammatory markers are associated with increased delirium risk.
- Early identification of risk factors can guide interventions to prevent delirium and reduce adverse outcomes.
Background:
A significant proportion of patients with coronavirus disease 2019 (COVID-19) suffer from delirium during hospitalization. This single-center observational study investigates the occurrence of delirium, the associated risk factors and its impact on in-hospital mortality in an Italian cohort of COVID 19 inpatients.
Methods:
Data were collected in the COVID units of a general medical hospital in the South of Italy. Socio-demographic, clinical and pharmacological features were collected. Diagnosis of delirium was based on a two-step approach according to 4AT criteria and DSM5 criteria. Outcomes were: dates of hospital discharge, Intensive Care Unit (ICU) admission, or death, whichever came first. Univariable and multivariable proportional hazards Cox regression models were estimated, and risks were reported as hazard ratios (HR) along with their 95% confidence intervals (95% CI).
Results:
A total of 47/214 patients (22%) were diagnosed with delirium (21 hypoactive, 15 hyperactive, and 11 mixed). In the multivariable model, four independent variables were independently associated with the presence of delirium: dementia, followed by age at admission, C-reactive protein (CRP), and Glasgow Coma Scale. In turn, delirium was the strongest independent predictor of death/admission to ICU (composite outcome), followed by Charlson Index (not including dementia), CRP, and neutrophil-to-lymphocyte ratio. The probability of reaching the composite outcome was higher for patients with the hypoactive subtype than for those with the hyperactive subtype.
Conclusions:
Delirium was the strongest predictor of poor outcome in COVID-19 patients, especially in the hypoactive subtype. Several clinical features and inflammatory markers were associated with the increased risk of its occurrence. The early recognition of these factors may help clinicians to select patients who would benefit from both non-pharmacological and pharmacological interventions in order to prevent delirium, and in turn, reduce the risk of admission to ICU or death.
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