Di Giorgio Annabella, Mirijello Antonio, De Gennaro Clara, Fontana Andrea, Alboini Paolo Emilio, Florio Lucia, Inchingolo Vincenzo, Zarrelli Michele, Miscio Giuseppe, Raggi Pamela, Marciano Carmen, Antonioni Annibale, De Cosmo Salvatore, Aucella Filippo, Greco Antonio, Carella Massimo, Copetti Massimiliano, Leone Maurizio A
Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
Internal Medicine Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
Diagnostics (Basel). 2022 Feb 20;12(2):544. doi: 10.3390/diagnostics12020544.
A significant proportion of patients with coronavirus disease 2019 (COVID-19) suffer from delirium during hospitalization. This single-center observational study investigates the occurrence of delirium, the associated risk factors and its impact on in-hospital mortality in an Italian cohort of COVID 19 inpatients.
Data were collected in the COVID units of a general medical hospital in the South of Italy. Socio-demographic, clinical and pharmacological features were collected. Diagnosis of delirium was based on a two-step approach according to 4AT criteria and DSM5 criteria. Outcomes were: dates of hospital discharge, Intensive Care Unit (ICU) admission, or death, whichever came first. Univariable and multivariable proportional hazards Cox regression models were estimated, and risks were reported as hazard ratios (HR) along with their 95% confidence intervals (95% CI).
A total of 47/214 patients (22%) were diagnosed with delirium (21 hypoactive, 15 hyperactive, and 11 mixed). In the multivariable model, four independent variables were independently associated with the presence of delirium: dementia, followed by age at admission, C-reactive protein (CRP), and Glasgow Coma Scale. In turn, delirium was the strongest independent predictor of death/admission to ICU (composite outcome), followed by Charlson Index (not including dementia), CRP, and neutrophil-to-lymphocyte ratio. The probability of reaching the composite outcome was higher for patients with the hypoactive subtype than for those with the hyperactive subtype.
Delirium was the strongest predictor of poor outcome in COVID-19 patients, especially in the hypoactive subtype. Several clinical features and inflammatory markers were associated with the increased risk of its occurrence. The early recognition of these factors may help clinicians to select patients who would benefit from both non-pharmacological and pharmacological interventions in order to prevent delirium, and in turn, reduce the risk of admission to ICU or death.
相当一部分2019冠状病毒病（COVID-19）患者在住院期间会出现谵妄。这项单中心观察性研究调查了意大利一组COVID-19住院患者中谵妄的发生情况、相关危险因素及其对院内死亡率的影响。
在意大利南部一家综合医院的COVID病房收集数据。收集社会人口统计学、临床和药理学特征。谵妄的诊断基于根据4AT标准和DSM5标准的两步法。结局指标为：出院日期、重症监护病房（ICU）入院日期或死亡日期，以先出现者为准。估计单变量和多变量比例风险Cox回归模型，并将风险报告为风险比（HR）及其95%置信区间（95%CI）。
共有47/214例患者（22%）被诊断为谵妄（21例活动减退型、15例活动亢进型和11例混合型）。在多变量模型中，四个独立变量与谵妄的存在独立相关：痴呆，其次是入院年龄、C反应蛋白（CRP）和格拉斯哥昏迷量表。反过来，谵妄是死亡/入住ICU（复合结局）的最强独立预测因素，其次是查尔森指数（不包括痴呆）、CRP和中性粒细胞与淋巴细胞比值。活动减退型亚型患者达到复合结局的概率高于活动亢进型亚型患者。
谵妄是COVID-19患者不良结局的最强预测因素，尤其是在活动减退型亚型中。几种临床特征和炎症标志物与其发生风险增加相关。早期识别这些因素可能有助于临床医生选择能从非药物和药物干预中获益的患者，以预防谵妄，进而降低入住ICU或死亡的风险。
