Delirium common consequence of severe COVID-19, study finds

A new study of nearly 150 patients hospitalized for the novel coronavirus (COVID-19) at the beginning of the pandemic found that 73 percent had delirium, a serious disturbance in mental state wherein a patient is confused, agitated, and unable to think clearly, according to research by Michigan Medicine published in The BMJ.

Patients with delirium tended to be sicker, with more comorbidities like hypertension and diabetes, and appeared to have more severe COVID-19-related illness as well, the researchers said. Using patient medical records and telephone surveys following hospital discharge for a group of patients hospitalized in the intensive care unit between March 2020 and May 2020, the study team attempted to identify common threads amongst patients who developed delirium.

The disease itself can lead to reduced oxygen to the brain as well as the development of blood clots and stroke, resulting in cognitive impairment, the researchers said. In addition, inflammatory markers were greatly increased in patients with delirium. Confusion and agitation could be a result of inflammation of the brain.

Additionally, care teams often were unable to perform standard delirium reduction techniques, such as exercises designed to get a patient moving or allowing visitors or objects from home to orient patients while in the hospital. Furthermore, there was a correlation between the use of sedatives and delirium—patients with delirium were sedated more often and frequently at higher doses.

The study also found that cognitive impairment can persist even after discharge. Almost a third of patients did not have their delirium marked as resolved in their chart upon leaving the hospital and 40 percent of these patients required skilled nursing care. Almost a quarter of patients screened positive for delirium based on assessment by their caretaker. For some patients, these symptoms lasted for months. This can make managing the recovery process after hospitalization that much more difficult, the researchers said.

The researchers concluded that for patients hospitalized with severe COVID-19, cognitive impairmen, including depression and delirium, is highly likely.

“Overall, this study highlights another reason why getting vaccinated and preventing severe illness is so important,” said Phillip Vlisides, MD, lead author of the study, in a statement. “There can be long term neurological complications that perhaps we don’t talk about as much as we should.”

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