Introduction
COVID-19 is caused by the SARS CoV-2 virus and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. The illness's main symptoms involve respiratory and gastrointestinal systems, along with constitutional symptoms as fever and chills. Previous studies also noted the presence of neurological and psychiatric symptoms (including delirium) in a subset of patients. By definition of diagnostic and statistical manual of mental disorders, DSM-5, delirium is defined as a disturbance in attention and awareness that is accompanied by an acute loss in cognition that cannot be better accounted for by a preexisting or evolving dementia. In this study, we aimed to explore the types of delirium associated with COVID-19 illness and explore the clinical characteristics of those patients.
Methods
We reviewed the medical records of all patients admitted to the University Hospital of Brooklyn from March 12, 2020, to May 1, 2020, who had a positive COVID-19 RNA PCR test. We then selected patients with clinically documented delirium for detailed chart review. We used specific words mentioned in the patient chart to classify patients either to hypo-arousal (HPO) (e.g., somnolent) or hyper-arousal (HPA) (e.g., agitated) delirium. We collected clinical, laboratory, and radiologic variables from patients selected for chart review. Data analysis was performed using the Mann-Whitney U test for continuous and Fisher exact test for categorical variables. Our study was approved by the Institutional Review Board of SUNY Downstate Health Sciences University.
Results
A total of 721 patients with positive COVID-19 PCR testing were admitted during the seven weeks of the study, of which 284 (32%) presented with neurological or psychiatric manifestations and were included in the detailed chart review. Of these, 53 (18.7%) patients were excluded for various reasons (including incomplete documentation of their mental status or vague psychiatric symptoms). Hence, we included 231 patients in the statistical analysis. 133 (57.6%) sample subjects were males, and 208 (89.3%) were of black ethnicity. The HPA group was more overweight than the HPO group (median BMI 29.7 compared to 26.3, p = 0.0106). The HPO group had higher random blood sugar on presentation (median 177 mg/dL compared to 137.5 mg/dL, p = 0.036) and a higher creatinine level (median 2 mg/dL compared to 1.5 mg/dL, p = 0.0377).
Conclusion
Further studies are needed to confirm 1) if there is an association between obesity and risk for hyperarousal delirium in COVID-19 infection, and if such an association is causal; 2) if there is an association between increased blood sugar and creatinine levels and hypoarousal delirium in COVID-19 patients, and if so its mechanism and significance.