Damanti Sarah, Bozzolo Enrica, Franchini Stefano, Frangi Claudia, Ramirez Giuseppe Alvise, Pedroso Carla, Di Lucca Giuseppe, Scotti Raffaella, Valsecchi Davide, Cilla Marta, Cinel Elena, Santini Chiara, Castellani Jacopo, Manzo Emanuela, Vadruccio Stefania, Spessot Marzia, Borghi Giovanni, Monti Giacomo, Landoni Giovanni, Rovere-Querini Patrizia, Yacoub Mona-Rita, Tresoldi Moreno
Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy.
Emerg Med J. 2023 Mar;40(3):202-209. doi: 10.1136/emermed-2021-211749. Epub 2022 Dec 15.
Respiratory infections can be complicated by acute brain failure. We assessed delirium prevalence, predictors and outcomes in COVID-19 ED patients.
This was a retrospective observational study conducted at the San Raffaele ED (Italy). Patients age >18 years attending the ED between 26 February 2020 and 30 May 2020 and who had a positive molecular nasopharyngeal swab for SARS-CoV-2 were included. The Chart-Based Delirium Identification Instrument (CHART-DEL) was used to retrospectively assess delirium. Univariable and multivariable logistic regression analyses were used to evaluate delirium predictors. Univariable binary logistic regression analyses, linear regression analyses and Cox regression analyses were used to assess the association between delirium and clinical outcomes. Age-adjusted and sex-adjusted models were then run for the significant predictors of the univariable models.
Among the 826 included patients, 123 cases (14.9%) of delirium were retrospectively detected through the CHART-DEL method. Patients with delirium were older (76.9±13.15 vs 61.3±14.27 years, p<0.001) and more frequently living in a long-term health facility (32 (26%) vs 22 (3.1%), p<0.001). Age (OR 1.06, 95% CI 1.04 to 1.09, p<0.001), dementia (OR 17.5, 95% CI 7.27 to 42.16, p<0.001), epilepsy (OR 6.96, 95% CI 2.48 to 19.51, p<0.001) and the number of chronic medications (OR 1.09, 95% CI 1.01 to 1.17, p=0.03) were significant predictors of delirium in multivariable analyses. Delirium was associated with increased in-hospital mortality (adjusted HR 2.16, 95% CI 1.55 to 3.03, p<0.001) and with a reduced probability of being discharged home compared with being institutionalised (adjusted OR 0.39, 95% CI 0.25 to 0.61, p<0.001).
Chart review frequently identified ED delirium in patients with COVID-19. Age, dementia, epilepsy and polypharmacy were significant predictors of ED delirium. Delirium was associated with an increased in-hospital mortality and with a reduced probability of being discharged home after hospitalisation. The findings of this single-centre retrospective study require validation in future studies.
呼吸道感染可能并发急性脑功能衰竭。我们评估了急诊科（ED）中新冠病毒疾病（COVID-19）患者的谵妄患病率、预测因素及预后情况。
这是一项在意大利圣拉斐尔急诊科开展的回顾性观察性研究。纳入了2020年2月26日至2020年5月30日期间在该急诊科就诊、年龄大于18岁且鼻咽拭子SARS-CoV-2分子检测呈阳性的患者。采用基于图表的谵妄识别工具（CHART-DEL）对谵妄进行回顾性评估。单因素和多因素逻辑回归分析用于评估谵妄的预测因素。单因素二元逻辑回归分析、线性回归分析和Cox回归分析用于评估谵妄与临床结局之间的关联。然后针对单因素模型中的显著预测因素运行年龄调整模型和性别调整模型。
在纳入的826例患者中，通过CHART-DEL方法回顾性检测到123例（14.9%）谵妄病例。谵妄患者年龄更大（76.9±13.15岁 vs 61.3±14.27岁，p<0.001），且更频繁地居住在长期医疗机构中（32例（26%） vs 22例（3.1%），p<0.001）。多因素分析中，年龄（比值比[OR] 1.06，95%置信区间[CI] 1.
