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

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic dramatically increased the number of patients requiring treatment in an intensive care unit (ICU) or invasive mechanical ventilation (IMV) 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 IMV. Among hospitalized COVID-19 patients, delirium incidence ranges from 11–80%, 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 years) 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 (CAM) for the intensive care unit or the CAM 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 1,017 (64.2% men; median age 54 years, 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 IMV. The median of days from admission to diagnosis was 14 (IQR 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 IMV (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.