PURPOSE: Incident delirium is a frequent complication among hospitalized older people with COVID-19, associated with increased length of hospital stay, higher morbidity and mortality rates. Although delirium is preventable with early detection, systematic assessment methods and predictive models are not universally defined, thus delirium is often underrated. In this study, we tested the role of the Multidimensional Prognostic Index (MPI), a prognostic tool based on Comprehensive Geriatric Assessment, to predict the risk of incident delirium. METHODS: Hospitalized older patients (≥ 65 years) with COVID-19 infection were enrolled (n = 502) from ten centers across Europe. At hospital admission, the MPI was administered to all the patients and two already validated delirium prediction models were computed (AWOL delirium risk-stratification score and Martinez model). Delirium occurrence during hospitalization was ascertained using the 4A's Test (4AT). Accuracy of the MPI and the other delirium predictive models was assessed through logistic regression models and the area under the curve (AUC). RESULTS: We analyzed 293 patients without delirium at hospital admission. Of them 33 (11.3%) developed delirium during hospitalization. Higher MPI score at admission (higher multidimensional frailty) was associated with higher risk of incident delirium also adjusting for the other delirium predictive models and COVID-19 severity (OR = 12.72, 95% CI = 2.11-76.86 for MPI-2 vs MPI-1, and OR = 33.44, 95% CI = 4.55-146.61 for MPI-3 vs MPI-1). The MPI showed good accuracy in predicting incident delirium (AUC = 0.71) also superior to AWOL tool, (AUC = 0.63) and Martinez model (AUC = 0.61) (p < 0.0001 for both comparisons). CONCLUSIONS: The MPI is a sensitive tool for early identification of older patients with incident delirium.

Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany

Department 2 of Internal Medicine and Center for Molecular Medicine Cologne Faculty of Medicine Ageing Clinical Research University Hospital Cologne Cologne Germany

Department of Geriatric Care Neurology and Rehabilitation Galliera Hospital Genoa Italy

Department of Geriatrics 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Geriatrics University Medical Center Göttingen Göttingen Germany

Department of Interdisciplinary Medicine Aldo Moro University of Bari Bari Italy

Department of Internal Medicine and Geriatrics University of Palermo Palermo Italy

Faculty of Health and Social Sciences University of South Bohemia Ceske Budejovice Czech Republic

Geriatrics Unit Mater Salutis Hospital Legnago ULSS 9 Scaligera Verona Italy

Geriatrics Unit Pugliese Ciaccio Hospital Catanzaro Italy

Infectious Disease Unit Sanremo Hospital ASL 1 Imperiese Sanremo Italy

Neurology Unit Department of Clinical and Experimental Sciences University of Brescia Brescia Italy

Servicio de Geriatría Hospital Universitario Ramón y Cajal Madrid Spain

Serviço de Medicina Interna Hospital Curry Cabral Centro Hospitalar Universitário Lisboa Central Universidade Nova de Lisboa Lisbon Portugal

University Clinic for Geriatric Medicine Klinikum Oldenburg AöR Oldenburg University Oldenburg Germany

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