Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-21T22:42:38.770Z Has data issue: false hasContentIssue false
  • English
  • Français

Delirium occurrence and association with outcomes in hospitalized COVID-19 patients

Published online by Cambridge University Press:  23 September 2021

Sandeep Pagali Open the ORCID record for Sandeep Pagali [Opens in a new window] ,
Sunyang Fu ,
Heidi Lindroth ,
Sunghwan Sohn ,
M. Caroline Burton  and
Maria Lapid
Sandeep Pagali*
Affiliation:
Assistant Professor, Department of Medicine, Division of Hospital Internal Medicine & Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA
Sunyang Fu
Affiliation:
Senior Data Science Analyst, Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
Heidi Lindroth
Affiliation:
Nurse Research Scientist, Doctorate in Nursing, Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, MN, USA
Sunghwan Sohn
Affiliation:
Associate Professor, Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
M. Caroline Burton
Affiliation:
Professor, Department of Medicine, Chair-Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
Maria Lapid
Affiliation:
Professor, Department of Psychiatry and Psychology & Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA
*
Correspondence should be addressed to: Sandeep R Pagali, MD, MPH, Assistant Professor of Medicine, Division of Hospital Medicine, 200 First St SW, Mayo Clinic, Rochester, MN55905, USA. Phone: 507-293-3589; Fax: 507-255-9189. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Delirium is reported to be one of the manifestations of coronavirus infectious disease 2019 (COVID-19) infection. COVID-19 hospitalized patients are at a higher risk of delirium. Pathophysiology behind the association of delirium and COVID-19 is uncertain. We analyzed the association of delirium occurrence with outcomes in hospitalized COVID-19 patients, across all age groups, at Mayo Clinic hospitals.

A retrospective study of all hospitalized COVID-19 patients at Mayo Clinic between March 1, 2020 and December 31, 2020 was performed. Occurrence of delirium and outcomes of mortality, length of stay, readmission, and 30-day mortality after hospital discharge were measured. Chi-square test, student t-test, survival analysis, and logistic regression analysis were performed to measure and compare outcomes of delirium group adjusted for age, sex, Charlson comorbidity score, and COVID-19 severity with no-delirium group.

A total of 4351 COVID-19 patients were included in the study. Delirium occurrence in the overall study population was noted to be 22.4%. The highest occurrence of delirium was also noted in patients with critical COVID-19 illness severity. A statistically significant OR 4.35 (3.27–5.83) for in-hospital mortality and an OR 4.54 (3.25–6.38) for 30-day mortality after discharge in the delirium group were noted. Increased hospital length of stay, 30-day readmission, and need for skilled nursing facility on discharge were noted in the delirium group. Delirium in hospitalized COVID-19 patients is a marker for increased mortality and morbidity. In this group, outcomes appear to be much worse when patients are older and have a critical severity of COVID-19 illness.

Keywords

deliriumhospitalized COVID-19outcomesCOVID-19 severity
Type
Brief Report
Information
International Psychogeriatrics , Volume 33 , Special Issue 10: Issue Theme: Non-cognitive Concerns in People with Dementia , October 2021 , pp. 1105 - 1109
Copyright
© International Psychogeriatric Association 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beach, S. R. et al. (2020). Delirium in COVID-19: a case series and exploration of potential mechanisms for central nervous system involvement. General Hospital Psychiatry, 65, 47–53. doi: 10.1016/j.genhosppsych.2020.05.008. Epub 2020 May 22.CrossRefGoogle ScholarPubMed
de Erausquin, G. A., Snyder, H., Carrillo, M., Hosseini, A. A., Brugha, T. S., Seshadri, S. and CNS SARS-CoV-2 Consortium. (2021). The chronic neuropsychiatric sequelae of COVID-19: the need for a prospective study of viral impact on brain functioning. Alzheimer's and Dementia, 17, 1056–1065. doi: 10.1002/alz.12255.CrossRefGoogle ScholarPubMed
Fu, S. et al. (2020). Ascertainment of delirium status using natural language processing from electronic health records. The Journals of Gerontology: Series A Biological Sciences Medical Sciences, glaa275. doi: 10.1093/gerona/glaa275.CrossRefGoogle ScholarPubMed
Helms, J. et al. (2020). Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients. Critical Care, 24, 491. doi: 10.1186/s13054-020-03200-1.CrossRefGoogle ScholarPubMed
Hosseini, A. A., Shetty, A. K., Sprigg, N., Auer, D. P. and Constantinescu, C. S. (2020). Delirium as a presenting feature in COVID-19: neuroinvasive infection or autoimmune encephalopathy? Brain, Behavior, and Immunity, 88, 68–70. doi: 10.1016/j.bbi.2020.06.012.CrossRefGoogle ScholarPubMed
Hshieh, T. T., Inouye, S. K. and Oh, E. S. (2019). Delirium in the Elderly. Clinics in Geriatric Medicine, 36, 183–199. doi: 10.1016/j.cger.2019.11.001.CrossRefGoogle Scholar
Kennedy, M. et al. (2020). Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Network Open, 3, e2029540. doi: 10.1001/jamanetworkopen.2020.29540.CrossRefGoogle ScholarPubMed
Pagali, S. R. et al. (2021). Predicting Delirium Risk Using an Automated Mayo Delirium Prediction Tool: Development and Validation of a Risk-Stratification Model. Mayo Clinic Proceedings, 96, P1229–P1235. doi: 10.1016/j.mayocp.2020.08.049.CrossRefGoogle ScholarPubMed
Pun, B. T. et al. (2021). Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respiratory Medicine, 9, P239–P250. doi: 10.1016/S2213-2600(20)30552-X.CrossRefGoogle ScholarPubMed
WHO. Clinical Management of Covid-19—Interim Guidance. Available online: https://www.who.int/publications/i/item/clinical-management-of-covid-19; accessed 15 January 2021.Google Scholar