EvergreenHealth Medical Center, Evergreen Neuroscience Institute, Kirkland, Washington.
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Cogn Behav Neurol. 2022 Jun 1;35(2):123-129. doi: 10.1097/WNN.0000000000000305.
Delirium is a common neurologic manifestation of coronavirus disease 2019 (COVID-19) in older adults who present to the emergency department (ED).
To investigate clinical characteristics associated with delirium as a presenting symptom of COVID-19 in older adults and develop a logistic regression to predict the likelihood of delirium.
We compared clinical characteristics in an age- and gender-matched sample of 68 delirious individuals with 68 nondelirious individuals (Mage = 78) who presented to the ED with COVID-19.
The delirious group was more likely to have neurologic, psychiatric, and cardiovascular comorbidities; a prior history of delirium; and deliriogenic medications in their medication list. They were less likely to present with respiratory symptoms and more likely to present with sepsis, hypoxia, higher heart rate, and higher sodium. The delirious group had higher mortality (51%) than the nondelirious group (32%). Delirium developed within an average of 2 days of initial COVID-19 symptom onset, with symptom onset to ED within an average of 4 days and symptom onset to death within an average of 11 days. Logistic regression based on five delirium predictors correctly predicted 80% of those with delirium (75% sensitivity at 86% specificity).
Our results are largely consistent with prior studies and suggest that delirium is a common, early occurring, and lethal manifestation of COVID-19 in older adults presenting to the ED, in most cases causing acute on chronic neurocognitive dysfunction strongly influenced by inflammatory and hypoxic-ischemic mechanisms.
在因 2019 年冠状病毒病（COVID-19）到急诊就诊的老年人中，谵妄是一种常见的神经系统表现。
研究与 COVID-19 以谵妄为首发症状有关的临床特征，并建立逻辑回归模型预测谵妄的可能性。
我们比较了 68 例因 COVID-19 到急诊就诊且伴有谵妄的老年患者（年龄和性别匹配，平均年龄为 78 岁）与 68 例不伴有谵妄的患者（平均年龄为 78 岁）的临床特征。
谵妄组更可能存在神经、精神和心血管合并症、谵妄病史和药物清单中存在致谵妄药物。他们更可能出现脓毒症、缺氧，而不太可能出现呼吸系统症状，且心率更高、血钠更高。谵妄组死亡率（51%）高于非谵妄组（32%）。谵妄平均在 COVID-19 首发症状出现后 2 天内发生，从首发症状到急诊就诊平均为 4 天，从首发症状到死亡平均为 11 天。基于 5 个谵妄预测因素的逻辑回归正确预测了 80%的谵妄患者（86%的敏感性和 75%的特异性）。
我们的研究结果与既往研究基本一致，提示谵妄是老年 COVID-19 患者常见的早期发生且致命的表现，大多数情况下导致急性加重慢性神经认知功能障碍，强烈受炎症和缺氧缺血机制的影响。
