WEBB FELLOW: Delirium in Critically Ill Cancer Patients With COVID-19

Introduction: COVID-19 has been a devastating pandemic with little known of its neuropsychiatric complications. Delirium is one of the most common neuropsychiatric syndromes among hospitalized cancer patients with incidence ranging from 25%-40% and rates of up to 85% in the terminally ill. Data on the incidence, risk factors, duration, and outcomes of delirium in critically ill cancer patients with COVID-19 are lacking.

Methods: Retrospective single-center study evaluating delirium frequency and outcomes in all critically ill cancer patients with COVID-19 admitted between March 1 and July 10, 2020. Delirium was assessed by Confusion Assessment Method - Intensive Care Unit (CAM-ICU), performed twice daily by trained ICU nursing staff. Patients were considered to have a delirium positive day if CAM-ICU was positive at least once per day.

Results: A total of 70 patients were evaluated. Of those 53 (75.7%) were found to be positive for delirium. Patients with delirium were significantly older compared to patients without delirium (median 67.5 vs 60.3, p=0.013). There were no significant differences in demographic characteristics, chronic medical conditions, neuropsychiatric history, cancer type, or application of prone positioning between the two groups. Delirium patients were less likely to receive cancer-directed therapies (58.5% vs 88.2%, p =0.038), but more likely to receive antipsychotics (81.1% vs 41.2%; p=0.004), dexmedetomidine (79.3% vs 11.8% p< 0.001), steroids (84.9% vs 58.8% p=0.039), and vasopressors (90.6% vs 58.8% p=0.006). Delirium patients were more likely to be intubated (86.8% vs 41.2%; p< 0.001) and all tracheostomies (35.9%) occurred in patients with delirium. ICU length of stay (LOS) (19 vs 8 days; p< .001) and hospital LOS (37 vs 12 days; p< .001) were significantly longer in delirium patients but there was no statistically significant difference in-hospital mortality (43.4% vs 58.8%; p=0.403) or ICU mortality (34% vs 58.8% p=0.090)

Conclusion: Delirium in critically ill cancer patients with COVID-19 was associated with fewer cancer-directed therapies, and increased hospital and ICU LOS. However, delirium did not seem to impact hospital or ICU mortality.