Delirium and Adverse Outcomes in Hospitalized Patients withCOVID-19
Delirium and Adverse Outcomes in Hospitalized Patients withCOVID-19
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DOI：
10.1111/jgs.16803
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发表时间：
2020-09-05
影响因子：
6.3
通讯作者：
Avelino-Silva, Thiago J.
中科院分区：
文献类型：
--
作者：
Garcez, Flavia B.;Aliberti, Marlon J. R.;Avelino-Silva, Thiago J.
背景：目前对住院成人COVID-19患者急性精神变化与不良结局之间的关系知之甚少。目的了解新型冠状病毒肺炎住院患者谵妄的发生情况，并探讨其与不良结局的关系。设计：纵向观察研究。位于巴西圣保罗的第三大学医院致力于治疗COVID-19重症病例。参与者共有707名患者，年龄在50岁或以上，在2020年3月至5月期间连续入院。我们完成了电子医疗记录的详细审查，以收集我们的数据。我们使用基于图表的谵妄识别仪（CHART-DEL）来识别谵妄的发生。具有老年医学背景的训练有素的医生完成了所有的CHART-DEL评估。我们通过与参与者或其代理人的电话访谈来补充我们的基线临床信息。我们感兴趣的结局是院内死亡、住院时间、入住重症监护和呼吸机使用情况。我们调整了所有多变量分析，包括年龄、性别、临床病史、生命体征和相关实验室生物标志物（淋巴细胞计数、c反应蛋白、肾小球滤过率、d -二聚体和白蛋白）。结果：总的来说，我们在234名参与者（33%）中发现了谵妄。入院时，86例（12%）神志不清。我们在样本中观察到273例死亡（39%），在经历谵妄的患者中住院死亡率达到55%。谵妄与院内死亡相关，校正优势比为1.75(95%可信区间= 1.15-2.66)；这种联系在中年和老年人中都成立。谵妄也与住院时间延长、进入重症监护和呼吸机使用有关。结论50岁及以上成人COVID-19患者谵妄与院内死亡独立相关。尽管在大流行期间患者护理存在困难，但临床医生在评估COVID-19患者的严重程度和预后时应定期监测谵妄。
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 A total of 707 patients, aged 50 years or older, 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, and albumin). RESULTS Overall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) 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 of 1.75 (95% confidence interval = 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 and older 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.