Delirium in COVID-19 and post-liver transplant patients: an observational study

Gianluca Fiore; Silvia Ferrari; Anna Cutino; Claudia Giorgino; Laura Valeo; Gian M Galeazzi; Mattia Marchi

doi:10.1080/13651501.2022.2026403

Delirium in COVID-19 and post-liver transplant patients: an observational study

Int J Psychiatry Clin Pract. 2022 Nov;26(4):343-351. doi: 10.1080/13651501.2022.2026403. Epub 2022 Jan 21.

Authors

Gianluca Fiore¹, Silvia Ferrari^{1

2

3}, Anna Cutino¹, Claudia Giorgino¹, Laura Valeo¹, Gian M Galeazzi^{1

2

3}, Mattia Marchi¹

Affiliations

¹ School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
² Section of Clinical Neurosciences, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
³ Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

PMID: 35061952
DOI: 10.1080/13651501.2022.2026403

Abstract

Objective: Delirium is a major complication in hospitalised patients. This study aimed to compare the mortality trends of patients with delirium according to the underlying physical condition.

Methods: Hospitalised patients diagnosed with delirium by the Modena Consultation-Liaison Psychiatry Service (Italy) during 2020 were enrolled. Three groups were identified: COVID; after orthotopic liver transplant (OLT); other conditions. The full medical records were screened to retrieve socio-demographic and clinical data. INTERMED score and Delirium Rating Scale were used to retrospectively rate bio-social-complexity and delirium severity. Early (20 days) and end of study (31^st January 2021) mortality were ascertained for each subject.

Results: A total of 103 patients were enrolled. Patients hospitalised for COVID showed higher INTERMED scores (two-tailed t-test, p = 0.019) and higher 20-day mortality (HR = 3.68, p = 0.014). When considering a 1-year follow-up, the main predictor of mortality was patients' age in all three subgroups (HR = 1.06; p = 0.003).

Conclusion: Our results suggest that patients hospitalised for COVID-19 with delirium showed higher bio-psycho-social complexity and higher short-term mortality, regardless of the severity of delirium. OLT patients showed lower mortality and bio-psycho-social complexity, despite being still considered as 'complex', according to the INTERMED score. Future research should focus on understanding the underlying mechanisms in the relationship between delirium and mortality.Key pointsPatients hospitalised for COVID-19 with delirium were found at risk of higher short-term mortality and higher bio-psycho-social complexity.OLT patients showed lower overall mortality and lower bio-psycho-social complexity than the other two groups, despite being still in the 'complex' range according to the INTERMED score.Future research should assess the areas of impact of delirium in patients affected by COVID-19, considering short- and long-term outcomes.

Keywords: COVID-19; INTERMED; consultation-liaison psychiatry; delirium; liver transplantation; mortality.

Publication types

Observational Study

MeSH terms

COVID-19* / complications
Delirium* / epidemiology
Delirium* / etiology
Humans
Liver Transplantation*
Referral and Consultation
Retrospective Studies