[Corticoid treatment and SARS-CoV-2 variants: two independent factors associated with COVID-19 mortality in a Spanish regional hospital].

BACKGROUND: Pandemic inter-wave hospital admissions and COVID-19-related mortality rates vary greatly. Some of the factors that may be playing part in this are the profile of the patients, viral variants, pharmacological treatments, or preventive measures. This work aimed to analyze the factors associated with mortality in COVID-19 patients admitted to hospital during 2020-2021. METHODS: Retrospective cohort study with COVID-19 patients admitted to Hospital de Barbastro (Spain) during 2020-2021. Data were collected from the Spanish Conjunto Mínimo Básico de Datos and microbiology and electronic prescription records. RESULTS: During the study period, 908 patients were consecutively admitted for COVID-19 (median age 70 years, 57.2% males); 162 (17.8%) patients died. We identified seven successive epidemiological waves. The following variables significantly associated to higher mortality: age, arterial hypertension, chronic renal failure, dementia, chronic obstructive pulmonary disease, heart failure, prior stroke, Charlson index, and wave 2; wave 4 was associated to greater survival. The multivariate analysis showed that age (OR=1.11; 95% CI: 1.09-1.14), chronic obstructive pulmonary disease (OR=2.33; 95% CI: 1.18-4.57), wave 2 (OR=2.57; 95% CI: 1.10-6.00), and wave 3 (OR=2.94; 95% CI: 1.17-7.38) associated with higher mortality. Glucocorticoid treatment was the only protective factor (OR=0.29; 95%CI: 0.14-0.62). CONCLUSIONS: This study confirms the therapeutic utility of glucocorticoids to reduce in-hospital mortality due to COVID-19. Heterogeneous mortality rates between the different COVID-19 waves suggest a direct role of viral variants as determinants of lethality, regardless of the patient's history.

Tratamiento corticoide y variantes SARS-CoV-2: dos factores independientes de mortalidad por COVID-19 en un hospital comarcal / Corticoid treatment and SARS-CoV-2 variants: two independent factors associated with COVID-19 mortality in a Spanish regional hospital

Fundamento: Existe gran heterogeneidad en tasas de ingresohospitalario y mortalidad derivada entre olas de COVID-19, pudiendo deberse al perfil de paciente, las variantes virológicas, lostratamientos y las medidas preventivas. El objetivo de este trabajoes analizar los factores asociados a mortalidad de pacientes ingresados por infección COVID-19 hasta finales de 2021.Métodología: Estudio de cohortes retrospectivo de pacientes COVID-19 en el Hospital General de Barbastro durante 2020 y 2021.Los datos se obtuvieron del Conjunto Mínimo Básico de Datos(CMBD), de registros de Microbiología y de prescripción electrónica de fármacos.Resultados: En el periodo de estudio ingresaron consecutivamente 908 pacientes por COVID-19 (mediana de 70 años, 57,2%varones), de los que 162 fallecieron (17,8%). Identificamos sieteolas epidemiológicas sucesivas. Las variables significativamenteasociadas a una mayor mortalidad fueron: edad, antecedentesde hipertensión arterial, insuficiencia renal crónica, demencia,EPOC, insuficiencia cardiaca, ictus previo, puntuación Charlsony la ola 2; la ola 4 se asoció a mayor supervivencia. En el análisismultivariante las variables asociadas a mayor mortalidad fueron:edad (OR=1,11; IC95%: 1,09-1,14), EPOC (OR=2,33; IC95%: 1,18-4,57), y las olas 2 (OR=2,57; IC95%: 1,10-6,00) y 3 (OR=2,94; IC95%:1,17-7,38); el tratamiento con glucocorticoides actuó como factorprotector (OR=0,29; IC95%: 0,14-0,62).Conclusiones: Este estudio confirma la utilidad terapéutica de losglucocorticoides para disminuir la mortalidad hospitalaria porCOVID-19. La diferente mortalidad entre las distintas olas epidemiológicas sugiere un papel directo de las variantes virológicascomo determinantes de la letalidad, independientemente de losantecedentes del paciente.(AU)

Background: Pandemic inter-wave hospital admissions andCOVID-19-related mortality rates vary greatly. Some of thefactors that may be playing part in this are the profile of thepatients, viral variants, pharmacological treatments, or preventive measures. This work aimed to analyze the factors associated with mortality in COVID-19 patients admitted to hospitalduring 2020-2021.Methods: Retrospective cohort study with COVID-19 patientsadmitted to Hospital de Barbastro (Spain) during 2020-2021. Datawere collected from the Spanish Conjunto Mínimo Básico de Datos and microbiology and electronic prescription records.Results: During the study period, 908 patients were consecutively admitted for COVID-19 (median age 70 years, 57.2%males); 162 (17.8%) patients died. We identified seven successive epidemiological waves. The following variables significantly associated to higher mortality: age, arterial hypertension,chronic renal failure, dementia, chronic obstructive pulmonarydisease, heart failure, prior stroke, Charlson index, and wave2; wave 4 was associated to greater survival. The multivariateanalysis showed that age (OR=1.11; 95% CI: 1.09-1.14), chronic obstructive pulmonary disease (OR=2.33; 95% CI: 1.18-4.57),wave 2 (OR=2.57; 95% CI: 1.10-6.00), and wave 3 (OR=2.94; 95%CI: 1.17-7.38) associated with higher mortality. Glucocorticoidtreatment was the only protective factor (OR=0.29; 95%CI: 0.14-0.62).Conclusions: This study confirms the therapeutic utility of glucocorticoids to reduce in-hospital mortality due to COVID-19.Heterogeneous mortality rates between the different COVID-19waves suggest a direct role of viral variants as determinants oflethality, regardless of the patient’s history.(AU)

Burn-out syndrome in Spanish internists during the COVID-19 outbreak and associated factors: a cross-sectional survey.

OBJECTIVES: The objective of this study is to evaluate the impact of the COVID-19 outbreak on mental health and burn-out syndrome in Spanish internists and the factors that could be related to its appearance. DESIGN: We performed an observational, cross-sectional, descriptive study for which we designed a survey that was distributed in May 2020. SETTING: We included internists who worked in Spain during the COVID-19 outbreak. PARTICIPANTS: A total of 1015 internists responded to the survey. Of those 62.9% were women. RESULTS: Of 1015 people, 58.3% presented with high emotional exhaustion, 61.5% had a high level of depersonalisation and 67.6% reported low personal fulfilment. 40.1% presented with the 3 criteria described, and therefore burn-out syndrome.Burn-out syndrome was independently related to the management of patients with SARS-CoV-2 (HR: 2.26; 95% CI 1.15 to 4.45), the lack of availability of personal protective equipment (HR: 1.41; 95% CI 1.05 to 1.91), increased responsibility (HR: 2.13; 95% CI 1.51 to 3.01), not having received financial compensation for overtime work (HR: 0.43; 95% CI 0.31 to 0.62), not having rested after 24-hour shifts (HR: 1.61; 95% CI 1.09 to 2.38), not having had holidays in the previous 6 months (HR: 1.36; 95% CI 1.01 to 1.84), consumption of sleeping pills (HR: 1.83; 95% CI 1.28 to 2.63) and higher alcohol intake (HR: 1.95; 95% CI 1.39 to 2.73). CONCLUSIONS: During the COVID-19 outbreak, 40.1% of Internal Medicine physicians in Spain presented with burn-out syndrome, which was independently related to the assistance of patients with SARS-CoV-2, overworking without any compensation and the fear of being contagious to their relatives. Therefore, it is imperative to initiate programmes to prevent and treat burn-out in front-line physicians during the COVID-19 outbreak.