Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study.

PURPOSE: The occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP). PATIENTS AND METHODS: This cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses. RESULTS: A total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74-88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01-1.85) for every 50 mg/L increase. CONCLUSION: In this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.

Risk Factors for Recurrent Diabetic Ketoacidosis in Adults With Type 1 Diabetes.

OBJECTIVES: Identification of risk factors for recurrent diabetic ketoacidosis (DKA) in patients with type 1 diabetes could help target those at high risk so as to implement preventive measures. The main objective of this study was to identify factors associated with recurrent DKA in adult Canadian patients with type 1 diabetes. METHODS: This is a retrospective cohort study of adult patients who had a diagnosis of type 1 diabetes for at least 1 year and who were hospitalized for an isolated or recurrent DKA episode between January 2007 and January 2017 in 5 Québec City tertiary care hospitals. Factors associated with recurrent DKA in bivariate logistic regression with a p value <0.1 were included in a multivariate analysis. Results are reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We included 212 patients who met the inclusion criteria. Of these, 141 and 71 had an isolated episode or recurrent DKA episodes, respectively. Problems of alcohol or illicit drug abuse (OR 2.81; 95% CI 1.55 to 5.07; p<0.01) and higher glycated hemoglobin levels (OR 1.26; 95% CI 1.08 to 1.47; p<0.01) were associated with recurrent DKA in bivariate analysis. However, only nonadherence to insulin therapy (OR 26.29; 95% CI 1.78 to 388.5; p=0.02) was significantly associated with recurrent DKA in the multivariate analysis, although a diagnosis of psychiatric illness was possibly another risk factor (OR 2.72; 95% CI 0.94 to 7.89; p=0.06). CONCLUSIONS: Interventions targeting adherence to insulin therapy, and possibly also psychiatric illness, could help reduce recurrent DKA in patients with type 1 diabetes.