Delirium severity and outcomes of critically ill COVID-19 patients.

Publisher: Associação de Medicina Intensiva Brasileira Country of Publication: Brazil NLM ID: 9918627781706676 Publication Model: Print Cited Medium: Internet ISSN: 2965-2774 (Electronic) Linking ISSN: 29652774 NLM ISO Abbreviation: Crit Care Sci Subsets: MEDLINE

Original Publication: São Paulo, SP, Brazil : Associação de Medicina Intensiva Brasileira, [2023]-

COVID-19* ; Delirium*; Humans ; Brazil ; Coma ; Critical Illness ; Prospective Studies

Objective: To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.
Methods: This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.
Results: Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.
Conclusion: In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.

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Date Created: 20240124 Date Completed: 20240125 Latest Revision: 20240127

20240127

PMC10802771

10.5935/2965-2774.20230170-en

38265321