Delirium impact in Covid-19 patients admitted in the ICU
Recent studies describe a neurotropism and an increased risk of delirium associated with the SARS-CoV2 infection. The aim of this study was to describe the impact of delirium in ICU patients with COVID-19 and the factors associated with poor prognosis.
All patients admitted in the ICU with confirmed diagnosis of COVID-19 between May3th and July1st 2020 were included. We applied the CAM-ICU7 during the first 7 of admission and severity scores and laboratorial data were recorded.
From 180 patients, 117 were included. Delirium occurred in 52 (44%) and coma in 24 (21%) patients. Comparing normal mental status with delirium, the median age was 70 years (CI 95% 74.64-61.8) vs 83 years (CI 95% 84.3-70.6) , p-value 0.006; SAPS3 was 45.07 (CI 95% 40.36-49.77) vs 57.31 ( CI 95% 53.89-60.74), p value <0.0053. and Dimero-D values was:1495 (CI 95% 903-2086) vs 3471 (CI 95% 2478-4464), p-value 0.056. In-hospital mortality was 7.32% vs 26.92%, p-value 0.0309; median length of hospital stay was: 17.63 days (CI 95% 13.7-26.01) vs 23.63 days (CI 95% 19.0-31.4), p-value 0.135. According to the multivariable analysis the CAM-ICU7 (each point) were associated with a increased risk of coma (OR 2.87, 1.53-6.47, p-value 0.004) and need of mechanical ventilation (OR 2.04, 1.22-3.85, p-value=0.013). Comparing the CAM-ICU7 with SAPS3 in predicting mortality ACUROC was similar (respectively 0.778 vs 0.776).
The incidence of delirium and coma in COVID-19 patients were high. Delirium was associate with high mortality. The CAM-ICU7 can help in predict patients with worse prognosis.