Confusion, delirium, multiorgan damage hallmarks of COVID-19 in older patients

The novel coronavirus disease (COVID-19) presents as a severe disease in most of the older patients and carries distinctive features, such as multiorgan injury and confusion and delirium, a new study reports.

“The current study emphasizes the need for early identification [and] intensive surveillance leading to appropriate care management of SARS-CoV-2 infection. Preventive strategies to avoid transmission to this particularly vulnerable patient setting still remain in great need,” the researchers said.

From a prospective cohort of 76 older COVID-19 patients (median age, 90 [86–92] years; 55.3 percent female), almost all (97.4 percent; n=74) presented with medical comorbidities, with more than half (64.5 percent; n=49) having three or more. Twenty-two patients died, most of whom were male. The resulting case fatality rate at day 21 was 28.9 percent.

The most common presenting symptoms were asthenia (76.3 percent) and fever (75.0 percent), followed closely by confusion or delirium (71.1 percent). Notably, in two patients, confusion was the only symptom. In addition, 25 percent of the participants had recorded initial falls at disease onset.

In terms of laboratory results, 88.2 percent of the participants had lymphopoenia, while 14.5 percent had thrombocytopoenia. Kidney injury was reported in 9.2 percent (n=7) of the patients. Among nonsurvivors, levels of various biomarkers such as lymphocyte count at nadir, C-reactive protein (CRP), serum creatinine, and albumin were all significantly altered.

However, only nadir lymphocyte count (hazard ratio [HR], 0.186, 95 percent confidence interval [CI], 0.037–0.932) and CRP (HR, 1.012, 95 percent CI, 1.005–1.019) emerged as significant and independent predictors of mortality, according to multivariate Cox proportional hazards analysis.