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Callea A, Conti G, Fossati B, Carassale L, Zagaria M, Caporotundo S, Ziglioli E, Brunetti V, Della Marca G, Rollo E. Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study. Intern Emerg Med 2022; 17:1445-1452. [PMID: 35084645 PMCID: PMC8793095 DOI: 10.1007/s11739-022-02934-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/15/2022] [Indexed: 12/15/2022]
Abstract
Delirium is an acute confusional state characterized by altered level of consciousness and attention. Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), can manifest itself with this neuropsychiatric disorder. The endpoints of our study were: the frequency of delirium in subjects with COVID-19 pneumonia; the risk factors that predispose to this condition; and the impact of delirium on mortality. Subjects were consecutively enrolled in a Geriatric Unit from January 5th to March 5th, 2021. Inclusion criteria were: diagnosis of SARS-CoV-2 infection, a radiologically documented pneumonia, and the ability of providing informed consent. Exclusion criteria were: absence of radiological evidence of pneumonia, sepsis, and the need of intensive care unit treatment. All subjects were evaluated by means of Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at least twice per day. In the study cohort (n = 71), twenty patients (28.2%) had delirium. Delirium was present on admission in 11.3%, and occurred during hospitalization in 19.0%. Compared to patients without delirium, patients who developed this neuropsychiatric disorder had a higher mortality rate (35% vs 5.9%) and an increased average hospital length of stay (21 days vs 17 days). In the multivariate analysis delirium was associated with frailty (OR = 2.81; CI = 1.4-5.8) and helmet ventilation (OR = 141.05; CI = 4.3-4663.9). Delirium was an independent predictor of mortality. Nearly a third of subjects (28.2%) had delirium during hospitalization for COVID-19. This finding supports the notion that delirium is a common complication of SARS-CoV2 infection. Since delirium is associated with longer hospital stay, and it is an independent marker of increased mortality, clinicians should assess and prevent it.
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Affiliation(s)
- Antonio Callea
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, 20092, Milan, Cinisello Balsamo, Italy.
| | - Giancarlo Conti
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, 20092, Milan, Cinisello Balsamo, Italy
| | - Barbara Fossati
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Massimo Gorki, 50, 20092, Milan, Cinisello Balsamo, Italy
| | - Laura Carassale
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Mariapia Zagaria
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Silvia Caporotundo
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Eleonora Ziglioli
- Department of Geriatrics, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Valerio Brunetti
- Dipartimento Scienze Dell'Invecchiamento, Neurologiche, Ortopediche E Della Testa-Collo, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Della Marca
- Dipartimento Scienze Dell'Invecchiamento, Neurologiche, Ortopediche E Della Testa-Collo, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Rollo
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
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Sidoli C, Zambon A, Tassistro E, Rossi E, Mossello E, Inzitari M, Cherubini A, Marengoni A, Morandi A, Bellelli G, Tarasconi A, Sella M, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Porcella L, Nardiello I, Chimenti E, Zeni M, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, Pietrogrande L, Mosca M, Corazzin I, Rossi P, Nunziata V, D’Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell’Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Borghi C, Bianchetti A, Crucitti A, DiFrancesco V, Fontana G, Geriatria A, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cassadonte F, Vatrano M, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Seneci F, Fimognari F, Bambar V, Saitta A, Corica F, Braga M, Servi, Ettorre E, Camellini Bellelli CG, Annoni G, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Formilan M, Patrizia G, Santuar L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl’Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Alessandro M, Calogero P, Corvalli G, Di F, Pezzoni D, Platto C, D’Ambrosio V, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Bonetto M, Grasso M, Troisi E, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Faraci B, Bertoletti E, Vannucci M, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D’Amico F, Grippa A, Mazzone A, Cottino M, Vezzadini G, Avanzi S, Brambilla C, Orini S, Sgrilli F, Mello A, Lombardi Muti LE, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D’Amico F, D’Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Cortegiani A, Pistidda L, D’Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clin Exp Res 2022; 34:1827-1835. [PMID: 35396698 DOI: 10.1007/s40520-022-02099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
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