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Meta-Analysis
. 2021 Oct:142:361-368.
doi: 10.1016/j.jpsychires.2021.08.031. Epub 2021 Aug 20.

Delirium is a good predictor for poor outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review, meta-analysis, and meta-regression

Timotius Ivan Hariyanto  1 , Cynthia Putri  1 , Joshua Edward Hananto  1 , Jessie Arisa  1 , Rocksy Fransisca V Situmeang  2 , Andree Kurniawan  3
Affiliations
Meta-Analysis

Delirium is a good predictor for poor outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review, meta-analysis, and meta-regression

Timotius Ivan Hariyanto et al. J Psychiatr Res. 2021 Oct.

Abstract

Aim: Delirium is a common presenting symptom among older patients. Patients who presented with delirium may have a higher morbidity and mortality rate due to older age, other comorbidities, and atypical COVID-19 presentation. Currently, the evidence supporting delirium as one of the predictors of poor outcome of COVID-19 is still insufficient. This study aims to explore the potential association between delirium and poor outcomes from COVID-19.

Methods: We systematically searched the PubMed and Google Scholar databases using specific keywords related to our aims until January 30th, 2021. All articles published on COVID-19 and delirium were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for case-series studies. Statistical analysis was done using Review Manager 5.4 software.

Results: Our meta-analysis of 20 studies showed that delirium symptoms on admission was associated with poor outcomes from COVID-19 [OR 2.36 (95% CI 1.80-3.09), p < 0.00001, I2 = 76%, random-effect models] and its subgroup which consist of severe COVID-19 [OR 3.89 (95% CI 1.72-8.75), p = 0.001, I2 = 91%, random-effect models], and mortality from COVID-19 [OR 1.90 (95% CI 1.55-2.33), p < 0.00001, I2 = 36%, random-effect models]. Meta-regression showed that the association was influenced by age (p = 0.005).

Conclusions: Our study suggests delirium as an important marker to identify patients at higher risk for developing poor COVID-19 outcomes. The physicians should add delirium as one of the common presenting symptoms of COVID-19 in older populations.

Keywords: COVID-19; Confusion; Coronavirus disease 2019; Delirium; Neurologic symptoms.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA diagram of the detailed process of selection of studies for inclusion in the systematic review and meta-analysis.
Fig. 2
Fig. 2
Forest plot that demonstrates the association of delirium symptoms with poor outcomes and its subgroup which comprises of severe COVID-19 and mortality.
Fig. 3
Fig. 3
Bubble-plot for Meta-regression. Meta-regression analysis showed that the association between delirium on admission and poor outcome was affected by age [A], but not by gender [B] and dementia [C].
Fig. 4
Fig. 4
Funnel plot analysis for the association of delirium symptoms with poor outcomes and its subgroup which comprises of severe COVID-19 and mortality.
See this image and copyright information in PMC

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