Delirium and adverse outcomes in hospitalized patients with COVID‐19.

Garcez, Flavia Barreto; Aliberti, Marlon Juliano Romero; Poco, Paula Cristina Eiras; Hiratsuka, Marcel; de Fatima Takahashi, Silvia; Coelho, Venceslau Antonio; Salotto, Danute Bareisys; Moreira, Marlos Luiz Villela; Jacob Filho, Wilson; Avelino Silva, Thiago J.

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.