Associations between delirium and SARS-CoV-2 pandemic visitor restrictions among hospitalized patients.

OBJECTIVES: Delirium is associated with increased morbidity and mortality, but environmental and behavioral factors may decrease the risk of developing delirium and thus must be considered. To investigate trends in delirium prevalence and examine associations of visitor restrictions with delirium diagnoses among all patients hospitalized during and prior to the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. STUDY DESIGN: Retrospective epidemiological assessment. METHODS: The medical records of all patients (n = 33,141) hospitalized within a three-hospital academic medical center system in a large Midwestern metropolitan area from March 20, 2019, through March 19, 2021, were analyzed. RESULTS: The overall prevalence of delirium during COVID-19 was 11.26% (confidence interval [CI]: 10.79%, 11.73%) compared to 9.28% (CI: 8.82%, 9.73%) before COVID-19. From our adjusted logistic regression analyses, we observed that the odds of delirium among non-isolated patients were significantly higher during COVID-19 visitor restrictions (adjusted odds ratio [aOR]: 1.354; 95% CI: 1.233, 1.488; P < 0.0001) than before. The odds of delirium among isolated patients were not significantly higher during COVID-19 visitor restrictions (aOR: 1.145; 95% CI: 0.974, 1.346; P = 0.1006) than before. CONCLUSIONS: Medically isolated patients remained at high risk of developing delirium both prior to and during COVID-19 era visitor restrictions. However, non-medically isolated patients had a significantly increased risk of delirium during the social isolation of visitor restrictions compared to prior to visitor restrictions.

Metabolic Effects of Androgen-associated Body Mass in Klinefelter Syndrome.

Patients with Klinefelter Syndrome (KS) are at increased risk for both diabetes and cardiovascular disease. While the anabolic effects of androgen replacement therapy may be associated with weight gain in such patients, the metabolic effects of this weight gain are unknown. Since untreated KS represents a natural example of androgen deprivation, we hypothesized that KS patients who are receiving androgen replacement would have a healthier metabolic risk factor profile, in addition to an increased Body Mass Index (BMI), relative to patients who are not receiving androgen replacement. Using de-identified data collected from Health Facts (a national, consolidated, and relational database of Electronic Health Records), we identified 2,447 adult patients with an ICD-9 billing code for KS. Of these, 262 patients were included in this study based on available anthropometrics, metabolic profiles, and information about androgen replacement. Multiple linear regression analysis was performed using BMI as the dependent variable in a model that included age, androgen replacement therapy (yes or no), A1C, blood pressure, and fasting lipids. Post-hoc comparisons were made using frequency analysis and the unpaired Student's t-test. There were 81 patients with KS who received androgen replacement and 181 patients who did not. In multiple regression, only androgen therapy was positively and significantly associated with BMI while adjusting for other risk factors (p=0.03). Post-hoc comparison of metabolic risk factors revealed no other differences between patients who received androgen replacement and those who did not. These data suggest that androgen replacement therapy in Klinefelter Syndrome is associated with increased BMI, but this increase does not appear to exert a detrimental effect on other metabolic risk factors in this condition.