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Introduction: Prognosis of Coronavirus disease 2019 (Covid-19) patients with vascular risk factors, and certain comorbidities is worse. The impact of chronic neurological disorders (CND) on prognosis is unclear. We evaluated if the presence of CND in Covid-19 patients is a predictor of a higher in-hospital mortality. As secondary endpoints, we analyzed the association between CND, Covid-19 severity, and laboratory abnormalities during admission. Methods: Retrospective cohort study that included all the consecutive hospitalized patients with confirmed Covid-19 disease from March 8th to April 11th, 2020. The study setting was Hospital Clínico, tertiary academic hospital from Valladolid. CND was defined as those neurological conditions causing permanent disability. We assessed demography, clinical variables, Covid-19 severity, laboratory parameters and outcome. The primary endpoint was in-hospital all-cause mortality, evaluated by multivariate cox-regression log rank test. We analyzed the association between CND, covid-19 severity and laboratory abnormalities. Results: We included 576 patients, 43.3% female, aged 67.2 years in mean. CND were present in 105 (18.3%) patients. Patients with CND were older, more disabled, had more vascular risk factors and comorbidities and fewer clinical symptoms of Covid-19. They presented 1.43 days earlier to the emergency department. Need of ventilation support was similar. Presence of CND was an independent predictor of death (HR 2.129, 95% CI: 1.382-3.280) but not a severer Covid-19 disease (OR: 1.75, 95% CI: 0.970-3.158). Frequency of laboratory abnormalities was similar, except for procalcitonin and INR. Conclusions: The presence of CND is an independent predictor of mortality in hospitalized Covid-19 patients. That was not explained neither by a worse immune response to Covid-19 nor by differences in the level of care received by patients with CND.
RESUMO
Objetivo: valorar los niveles de resiliencia, compromiso laboral (engagement) y agotamiento profesional (burnout) en el personal de Enfermería y conocer la relación entre ellos. Métodos: estudio descriptivo transversal en el personal enfermero en activo que ejercía como enfermera/o o técnico en cuidados auxiliares de Enfermería (TCAE) en el Complejo Asistencial de Segovia, durante el periodo de marzo-abril de 2016. Se registraron variables sociodemográficas, laborales y profesionales. Se usaron distintas escalas para valorar la resiliencia (escala CD-RISC), el compromiso laboral o engagement (escala UWES) y el agotamiento profesional o burnout (escala MBI-GS). Se realizó un análisis descriptivo. Se comprobó la correlación entre resiliencia, engagement y burnout, y la asociación entre ellas. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: participaron 42 sujetos. Prevalecieron niveles medios (45,2%) de engagement. Respecto al burnout, prevalecieron niveles medio-bajos (26,2%) en la dimensión de agotamiento emocional, en la dimensión de cinismo niveles medio-altos (31%), al igual que en la dimensión de eficacia (33,3%). Se registró un nivel alto de resilencia en el 16,7% de los participantes. La correlación de la resiliencia con el engagement y burnout fue de 0,661 y -0,561 respectivamente (ambas p< 0,001). La resiliencia estuvo asociada con los niveles de engagement (ß= 0,567, IC95%: 0,248-0,886, p= 0,001). En cambio, no hubo asociación entre resiliencia y niveles de burnout (ß= -0,096, IC95%= -0,433 a 0,240, p= 0,566). Conclusión: el personal de Enfermería del estudio presentó niveles medios de resiliencia, engagement y burnout, y parece existir una asociación entre la resiliencia y los niveles de engagement, pero no entre la resiliencia y los niveles de burnout
Objective: to assess the levels of resilience, work engagement and professional burnout among the Nursing staff, and to understand the relationship between them. Methods: a descriptive cross-sectional study with active nursing staff working as nurses or auxiliary nurse technicians at the Complejo Asistencial de Segovia, during March-April, 2016. Sociodemographical, occupational and professional variables were registered. Different scales were used to assess resilience (CD-RISC scale), work engagement (UWES scale), and professional burnout (MBI-GS scale). A descriptive analysis was conducted. The correlation between resilience, engagement and burnout was confirmed, as well as the association between them. The SPSS statistical program version 20.0 was used. Results: the study included 42 subjects; medium levels (45.2%) of engagement prevailed. Regarding burnout, there was a prevalence of medium-low levels (26.2%) in the emotional exhaustion dimension, and medium-high levels (31%) in the cynicism dimension, as well as in the efficacy dimension (33.3%). There was a high level of resilience in 16.7% of participants. The correlation of resilience with engagement and burnout was of 0.661 and -0.561 respectively (both p< 0.001). Resilience was associated with engagement levels (ß= 0.567, CI95%: 0.248-0.886, p= 0.001). On the other hand, there was no association between resilience and burnout levels (ß= -0.096, CI95%= -0.433 to 0.240, p= 0.566). Conclusion: the Nursing staff in the study presented medium levels of resilience, engagement and burnout, and there seemed to be an association between resilience and engagement levels, but not between resilience and burnout levels
