J Am Geriatr Soc. 2020 Aug 24. doi: 10.1111/jgs.16803. Online ahead of print.
BACKGROUND: Little is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID-19.
OBJECTIVES: To investigate the occurrence of delirium in hospitalized patients with COVID-19 and explore its association with adverse outcomes.
DESIGN: Longitudinal observational study.
SETTING: Tertiary university hospital dedicated to the care of severe cases of COVID-19 in Sao Paulo, Brazil.
PARTICIPANTS: 707 patients aged ≥50 years consecutively admitted to the hospital between March and May 2020.
MEASUREMENTS: We completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart-based Delirium Identification Instrument (CHART-DEL). Trained physicians with a background in geriatric medicine completed all CHART-DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in-hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C-reactive protein, glomerular filtration rate, D-dimer, albumin).
RESULTS: Overall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 263 deaths (37%) in our sample, and in-hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in-hospital death, with an adjusted odds ratio [aOR] of 1.75 (95% confidence interval [95%CI]= 1.15-2.66); the association held both in middle-aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization.
CONCLUSION: Delirium was independently associated with in-hospital death in adults aged ≥50 years with COVID-19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID-19 patients. This article is protected by copyright. All rights reserved.