Incidência e fatores associados à subsíndrome delirium e ao delirium em pacientes com covid-19 em uma Unidade de Terapia Intensiva na cidade de Congonhas-MG

Abstract

Introduction: Neurological manifestations associated with Coronavirus disease 19 (covid-19), caused by the coronaviridae SARS-CoV-2 directly or indirectly, are generally associated with Severe Acute Respiratory Syndrome (SARS) and are associated with increased severity and morbidity. Disorders of consciousness are among the most common manifestations in individuals with severe covid-19. Delirium (DL) and subsyndromal delirium (SSD) are disorders of consciousness that are associated with longer ICU stay, longer hospitalization, and increased mortality. However, there are still few studies on DL in individuals with covid-19 admitted to the ICU, and to date, there are no studies on SSD in this population. In this context, the present study was developed to evaluate the incidence of SSD and/or DL in patients admitted to the ICU with covid-19, as well as the sociodemographic, clinical, and laboratory factors associated with SSD and/or DL. Methods: This is an observational, longitudinal study conducted in the reference ICU for covid-19 in the city of Congonhas, Brazil. Between October 20, 2020, and October 20, 2021, all admitted individuals were screened for SSD and DL twice a day during the entire ICU stay using the Intensive Care Delirium Screening Checklist (ICDSC). Individuals who presented with SSD and/or DL were compared with individuals admitted to the ICU with covid-19 who did not score on the ICDSC. The following factors were evaluated in this comparison: age, comorbidities, disease severity at ICU admission by the APACHE II scale, laboratory tests, and clinical outcomes of duration of mechanical ventilation (MV), length of ICU stay, length of hospitalization, and mortality. Results: Ninety-three patients were evaluated, of whom 43 (46.7%) presented with SSD and/or DL. The incidence rate was 4.17 cases/100 persons-days. There was no significant difference between the groups in terms of age and comorbidities. Individuals who presented with SSD and/or DL had higher disease severity as assessed by the APACHE II score within the first 24 hours of ICU admission compared to controls (median 16 versus 8 points, p<0.001). SSD and/or DL were associated with longer ICU and hospital stay (median 19 versus 6 days, p<0.001, and median 22 versus 7 days, p<0.001, respectively). There was no statistically significant difference in terms of MV duration (p=0.847) and mortality (p=0.555). Conclusion: Individuals with SSD and/or DL had higher disease severity and longer ICU and hospital stay compared to individuals without SSD and/or DL. This study was the first to include individuals with SSD and highlights the importance of screening for disorders of consciousness to better estimate severity and duration of ICU and hospital stay, allowing for early treatment measures to be instituted to reduce hospital costs and increase ICU and hospital bed turnover.