College of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China.
Fujian Provincial Hospital, Fuzhou, China.
Int J Nurs Stud. 2023 Dec;148:104602. doi: 10.1016/j.ijnurstu.2023.104602. Epub 2023 Sep 6.
This study aims to systematically assess the risk factors, the overall strength of association, and evidence quality related to delirium among adults hospitalized with COVID-19.
A comprehensive search was conducted in thirteen databases from inception to February 10, 2023. The included databases were thoroughly searched, including PubMed, Web of Science, Proquest, Ovid MEDLINE, CINAHL, Scopus, the Cochrane Library, FMRS, Wanfang Database, Chinese Biomedical Database (CBM), China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Embase. The search was limited to articles published in English and Chinese. The selected studies were screened, data were extracted, and the quality was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software. The certainty of the evidence was assessed using the GRADE criteria.
A total of 22 cohort studies with a sample size of 11,957 individuals were included in the analysis. Among these studies, 20 were of high quality, while the remaining 2 were of moderate quality. The risk factors that showed the strongest association with delirium were prior cognitive impairment (including dementia), mechanical ventilation, and ICU admission. Age, frailty (Clinical Frailty Scale score > 5), antipsychotic use, benzodiazepine use, neutrophil-to-lymphocyte ratio, and vasopressor use were identified as moderate risk factors for delirium. According to the GRADE evaluation, ICU admission, benzodiazepine use, neutrophil-to-lymphocyte ratio, and vasopressor use had a high-quality body of evidence, while antipsychotic usage had an intermediate-quality body of evidence. All other risk factors had a low-quality body of evidence.
This systematic review and meta-analysis identified several medium- to high-intensity risk factors for delirium in hospitalized adults with COVID-19. ICU admission, benzodiazepine usage, neutrophil-to-lymphocyte ratio, antipsychotic use, and vasopressor use were associated with delirium and were supported by medium- to high-quality evidence. These findings provide healthcare professionals with an evidence-based basis for managing and treating delirium in hospitalized adults with COVID-19.
本研究旨在系统评估与 COVID-19 住院成人相关的谵妄的危险因素、关联强度以及证据质量。
从建库至 2023 年 2 月 10 日，我们在 13 个数据库中进行了全面检索。彻底检索了包括 PubMed、Web of Science、Proquest、Ovid MEDLINE、CINAHL、Scopus、Cochrane 图书馆、FMRS、万方数据库、中国生物医学文献数据库（CBM）、中国知识资源综合数据库（CNKI）、维普数据库（VIP）和 Embase 在内的纳入数据库。检索语言限定为英文和中文。筛选选定的研究，提取数据，并使用纽卡斯尔-渥太华量表评估质量。使用 RevMan 5.4 软件进行荟萃分析。使用 GRADE 标准评估证据的确定性。
共纳入了 22 项队列研究，包含 11957 名个体。其中，20 项研究质量较高，2 项研究质量为中等。与谵妄关联最强的危险因素包括先前的认知障碍（包括痴呆）、机械通气和 ICU 入院。年龄、虚弱（临床虚弱量表评分>5）、抗精神病药物使用、苯二氮䓬类药物使用、中性粒细胞与淋巴细胞比值和血管加压药使用被确定为谵妄的中度危险因素。根据 GRADE 评估，ICU 入院、苯二氮䓬类药物使用、中性粒细胞与淋巴细胞比值和血管加压药使用具有高质量的证据体，而抗精神病药物使用具有中等质量的证据体。所有其他危险因素的证据体质量均较低。
本系统评价和荟萃分析确定了 COVID-19 住院成人谵妄的几个中至高强度危险因素。ICU 入院、苯二氮䓬类药物使用、中性粒细胞与淋巴细胞比值、抗精神病药物使用和血管加压药使用与谵妄相关，并有中至高质量证据支持。这些发现为医护人员在 COVID-19 住院成人中管理和治疗谵妄提供了基于证据的基础。
