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Delirium and Associated Factors in a Cohort of Hospitalized Patients With Coronavirus Disease 2019.
García-Grimshaw, Miguel; Chiquete, Erwin; Jiménez-Ruiz, Amado; Vidal-Mayo, José de Jesús; Grajeda-González, Samara Lissete; Vargas-Martínez, María de Los Ángeles; Toapanta-Yanchapaxi, Liz Nicole; Valdés-Ferrer, Sergio Iván; Chávez-Martínez, Oswaldo Alan; Marché-Fernández, Osvaldo Alexis; Jiménez-Ávila, Ana Itiel; Cantú-Brito, Carlos; Flores-Silva, Fernando Daniel.
  • García-Grimshaw M; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Chiquete E; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Jiménez-Ruiz A; Stroke, Dementia & Heart Disease Laboratory, Western University, London, ON, Canada.
  • Vidal-Mayo JJ; Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Grajeda-González SL; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Vargas-Martínez MLÁ; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Toapanta-Yanchapaxi LN; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Valdés-Ferrer SI; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY.
  • Chávez-Martínez OA; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Marché-Fernández OA; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Jiménez-Ávila AI; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Cantú-Brito C; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Flores-Silva FD; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Electronic address: ferfs98@gmail.com.
J Acad Consult Liaison Psychiatry ; 63(1): 3-13, 2022.
Article in English | MEDLINE | ID: covidwho-1648932
ABSTRACT

BACKGROUND:

The coronavirus disease 2019 (COVID-19) pandemic dramatically increased the number of patients requiring treatment in an intensive care unit or invasive mechanical ventilation worldwide. Delirium is a well-known neuropsychiatric complication of patients with acute respiratory diseases, representing the most frequent clinical expression of acute brain dysfunction in critically ill patients, especially in those undergoing invasive mechanical ventilation. Among hospitalized patients with COVID-19, delirium incidence ranges from 11% to 80%, depending on the studied population and hospital setting.

OBJECTIVE:

To determine risk factors for the development of delirium in hospitalized patients with COVID-19 pneumonia.

METHODS:

We retrospectively studied consecutive hospitalized adult (≥18 y) patients with confirmed COVID-19 pneumonia from March 15 to July 15, 2020, in a tertiary-care hospital in Mexico City. Delirium was assessed by the attending physician or trained nurse, with either the Confusion Assessment Method for the Intensive Care Unit or the Confusion Assessment Method brief version, according to the appropriate diagnostic tool for each hospital setting. Consultation-liaison psychiatrists and neurologists confirmed all diagnoses. We calculated adjusted hazard ratios (aHR) with 95% confidence interval (CI) using a Cox proportional-hazards regression model.

RESULTS:

We studied 1017 (64.2% men; median age, 54 y; interquartile range 44-64), of whom 166 (16.3%) developed delirium (hyperactive in 75.3%); 78.9% of our delirium cases were detected in patients under invasive mechanical ventilation. The median of days from admission to diagnosis was 14 (interquartile range 8-21) days. Unadjusted mortality rates between delirium and no delirium groups were similar (23.3% vs. 24.1; risk ratio 0.962, 95% CI 0.70-1.33). Age (aHR 1.02, 95% CI 1.01-1.04; P = 0.006), an initial neutrophil-to-lymphocyte ratio ≥9 (aHR 1.81, 95% CI 1.23-2.65; P = 0.003), and requirement of invasive mechanical ventilation (aHR 3.39, 95% CI 1.47-7.84; P = 0.004) were independent risk factors for in-hospital delirium development.

CONCLUSIONS:

Delirium is a common in-hospital complication of patients with COVID-19 pneumonia, associated with disease severity; given the extensive number of active COVID-19 cases worldwide, it is essential to detect patients who are most likely to develop delirium during hospitalization. Improving its preventive measures may reduce the risk of the long-term cognitive and functional sequelae associated with this neuropsychiatric complication.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Delirium / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Acad Consult Liaison Psychiatry Year: 2022 Document Type: Article Affiliation country: J.jaclp.2021.06.008

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Delirium / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Acad Consult Liaison Psychiatry Year: 2022 Document Type: Article Affiliation country: J.jaclp.2021.06.008