COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study.
COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study.
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DOI：
10.1186/s12888-022-03809-2
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发表时间：
2022-02-28
期刊：
影响因子：
4.4
通讯作者：
Newman JC
中科院分区：
文献类型：
--
作者：
LaHue SC;Escueta DP;Guterman EL;Patel K;Harrison KL;Boscardin WJ;Douglas VC;Newman JC
尽管人们认识到与 SARS-CoV-2 感染相关的神经系统和精神并发症，但入院时冠状病毒病 19 (COVID-19) 严重程度与住院患者谵妄之间的关系仍知之甚少。本研究试图通过利用现有的全院系统性谵妄筛查方案来衡量重症监护病房 (ICU) 和急症护理患者中 COVID-19 严重程度与谵妄存在之间的关联。二次分析包括测量年龄与谵妄存在之间的关联，以及谵妄与安全护理人员使用、约束使用、出院回家和住院时间之间的关联。在这项单中心回顾性队列研究中，我们使用机构 Epic Clarity 数据库获得了电子病历 (EMR) 数据，以识别所有被诊断患有 COVID-19 并在 2020 年 2 月 1 日至 7 月 15 日期间住院至少 48 小时的成年人。COVID-19 的严重程度分为四组。这些 EMR 数据包括根据现有全院方案使用护理谵妄筛查量表（非 ICU）或 CAM-ICU (ICU) 对所有患者进行的每日两次谵妄筛查。共有 99 名患者被诊断患有 COVID-19，其中 44 名患者需要 ICU 护理，17 名患者在入院 24 小时内符合重症标准。四十三名患者 (43%) 在住院期间的任何时候都符合谵妄的标准。在谵妄患者中，24 名 (56%) 年龄在 65 岁或以下。调整后，入院 24 小时内符合两个最高 COVID-19 严重程度组标准的患者发生谵妄的几率是最低类别患者的 7.2 倍 [调整后比值比 (aOR) 7.2；调整后比值比 (aOR) 7.2； 95% 置信区间 (CI) 1.9、27.4； P = 0.003]。与 45 岁以下患者相比，65 岁以上患者发生谵妄的几率更高（aOR 8.7；95% CI 2.2, 33.5；P=0.003）。谵妄与使用安全护理人员的几率增加（aOR 4.5; 95% CI 1.0, 20.7; P = 0.050）、出院回家的几率降低（aOR 0.2; 95% CI 0.06, 0.6; P = 0.005）以及住院时间增加（aOR 7.5; 95% CI 2.0, 13; P = 0.008)。虽然谵妄在所有年龄段的 COVID-19 住院患者中都很常见，但在入院时患有严重疾病的患者和年龄较大的患者中尤其常见。与没有谵妄的 COVID-19 患者相比，患有 COVID-19 和谵妄的患者在住院期间更有可能需要安全护理人员，出院回家的可能性较小，并且住院时间更长。 COVID-19 患者（包括年轻患者）是谵妄筛查和管理的重要目标人群，因为谵妄与临床护理和处置方面的重要差异相关。
Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay. In this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols. A total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those < 45 years old (aOR 8.7; 95% CI 2.2, 33.5; P = 0.003). Delirium was associated with increased odds of safety attendant use (aOR 4.5; 95% CI 1.0, 20.7; P = 0.050), decreased odds of discharge home (aOR 0.2; 95% CI 0.06, 0.6; P = 0.005), and increased length of stay (aOR 7.5; 95% CI 2.0, 13; P = 0.008). While delirium is common in hospitalized patients of all ages with COVID-19, it is especially common in those with severe disease on hospital admission and those who are older. Patients with COVID-19 and delirium, compared to COVID-19 without delirium, are more likely to require safety attendants during hospitalization, less likely to be discharged home, and have a longer length of stay. Individuals with COVID-19, including younger patients, represent an important population to target for delirium screening and management as delirium is associated with important differences in both clinical care and disposition.
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影响因子：
81.5
作者：
Wilson, Jo Ellen;Mart, Matthew F.;Cunningham, Colm;Shehabi, Yahya;Girard, Timothy D.;MacLullich, Alasdair M. J.;Slooter, Arjen J. C.;Ely, E. Wesley
通讯作者：
Ely, E. Wesley
影响因子：
3.4
作者：
Hargrave A;Bastiaens J;Bourgeois JA;Neuhaus J;Josephson SA;Chinn J;Lee M;Leung J;Douglas V
通讯作者：
Douglas V
DOI：
10.1056/nejmcp1605501
发表时间：
2017-10-12
期刊：
The New England journal of medicine
影响因子：
--
作者：
Marcantonio ER
通讯作者：
Marcantonio ER
影响因子：
2.6
作者：
LaHue, Sara C;Maselli, Judy;Rogers, Stephanie;Casatta, Julie;Chao, Jessica;Croci, Rhiannon;Gonzales, Ralph;Holt, Brian;Josephson, S Andrew;Lama, Sudha;Lau, Catherine;McCulloch, Charles;Newman, John C;Terrelonge, Mark;Yeager, Jan;Douglas, Vanja C
通讯作者：
Douglas, Vanja C
影响因子：
15.1
作者：
Helms, Julie;Kremer, Stephane;Meziani, Ferhat
通讯作者：
Meziani, Ferhat