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Delirium Increases In-Hospital and Post-Discharge Mortality in COVID-19 Patients: The FRACOVID Multicenter Prospective Study
22 Pages Posted: 13 Apr 2022
More...Abstract
Background: Delirium is a common feature in COVID-19 patients. Although its association with in-hospital mortality has previously been reported, scarce results concern post-discharge mortality and delirium subtypes. We evaluated the association between delirium and its subtypes and both in-hospital and medium-term mortality.
Methods : This is a multicenter longitudinal clinical-based study settled in Monza and Brescia, Italy. 1324 patients (median age: 68) with COVID-19 admitted to four acute clinical wards in Northern Italy during the first and second pandemic waves. Delirium was assessed through validated scores and/or clinical assessment. The association between the presence of delirium - and its subtypes- and in-hospital and medium-term mortality was evaluated through Cox proportional hazards models.
Findings: 223 patients (16.8%) presented delirium within 24-48 hours of hospital admission. Those with delirium had around a two-fold increased risk of in-hospital (HR=1.94, 95%CI: 1.38, 2.73) and medium-term mortality (HR=2.01, 95%CI: 1.48, 2.73), than those without delirium. All delirium subtypes were associated with greater risk of death compared to the absence of delirium, but hypoactive delirium revealed the strongest associations, with both in-hospital (HR=2.03, 95%CI: 1.32, 3.13) and medium-term mortality (HR=2.22, 95%CI: 1.52, 3.26).
Interpretation: In patients with COVID-19, delirium at hospital admission is not only associated with in-hospital mortality but also with shorter post-discharge survival. This suggests that delirium might be a marker of disease severity and/or patient vulnerability. Its detection and management are crucial to improving the clinical prognosis of COVID-19 patients.
Funding: This work was supported by grants from the Cariplo Foundation, Lombardia Region, Italy.
Declaration of Interest: The authors declare no conflict of interest.
Ethical Approval: The study protocol was approved by Brianza Institutional Review Board under the number 3356-07/08/2020. Informed consent was obtained orally from all participants or their next of kin.
Keywords: COVID-19, delirium, mortality, prospective study.
Suggested Citation: Suggested Citation