Lung Ultrasound Aids Early Delirium Detection in Resource-Limited Settings: Study

Delirium, as a rapid onset of disorientation and confusion, is also common in hospitalized elderly with COVID-19 and reflects poor outcomes. Yet it is underdiagnosed, as its symptoms overlap with dementia and other cognitive disorders. In response to this diagnostic issue, a recent study at San Luigi Hospital sought to assess whether LUS abnormalities and cognitive screening could be useful tools for the early prediction of delirium.

We recruited 64 hospitalized patients with COVID-19 with a mean age of 82.6 years in this prospective observational study. All patients received a lung ultrasound to determine the LUS Extension Score (LUSext) for the extent of lung involvement. Cognitive performance was measured with the Mini-Mental State Examination (MMSE) and the 4AT test for delirium assessment. Apart from these, the investigators also gathered extensive clinical information, such as comorbidities and inflammatory markers. Statistical analysis included ROC curves and multivariate logistic regression to determine factors that were independently related to delirium.

Key Findings

Delirium was seen in 61.4% of the patients (35 out of 57 evaluable cases). Univariate analysis showed a significant correlation with several factors:

• Pre-existing dementia (p = 0.03)

• Increased LUSext scores (p = 0.004)

• Decreased MMSE scores (p = 0.0002)

• ROC curve analysis indicated that a LUSext score >3 was associated with 74% sensitivity and 82% specificity to predict delirium.

• On multivariate logistic regression, LUS score >3 was a persistent, independent predictor of delirium (Odds Ratio [OR] = 4.22, p = 0.023).

• For every point reduction in MMSE score, the odds of developing delirium increased (OR = 0.87, p = 0.007).

This analysis concludes that both high LUSext scores (>3) and low MMSE scores are independent and clinically useful predictors of delirium in older COVID-19 patients. Adding lung ultrasound and cognitive screening to routine hospital evaluations, clinicians can potentially improve earlier detection and preventive treatment for those at highest risk. Additional studies are needed to validate these findings and identify mechanisms underlying delirium in this high-risk population.

Reference:

Fraccalini, T., Bergoglio, I. R., Fonte, G., Trogolo, A., Maraschi, A., Roberts, T., Tarozzo, B., Vitorino, B., Vecchini, J. M., Mariangela, S., Traversa, M., Crea, T., Cardinale, L., Maina, G., Ricci, V., Binello, E., Turja, R., Mallamaci, F., & Volpicelli, G. (2025). Lung ultrasound (LUS) as a predictor of delirium in elderly patients with COVID-19 during hospitalization: A geriatric vulnerability-stress model. Archives of Gerontology and Geriatrics Plus, 2(3), 100186. https://doi.org/10.1016/j.aggp.2025.100186