Cardiovascular features and risk of mortality in COVID-19 hospitalized patients in Spain during 2020. A nationwide study from the Minimum Basic Data Set

Introduction: During the last two years scientific evidence has been gathered regarding the cardiovascular complications of Covid-19. Nevertheless nationwide studies are still required to better understand both the incidence of less frequent clinical findings, and the prognostic implications of cardiovascular COVID-19 complications. Purpose(s): The aim of this study was to estimate the incidence of cardiovascular diseases among COVID-19 hospitalized patients in Spain during 2020, as well as their association with mortality, besides other clinical and epidemiological factors. Method(s): We used the Minimum Basic Data Set from the Spanish Ministry of Health (RAE-CMBD) to analyze the data of all COVID-19 hospitalized patients in Spain during 2020. This national database includes concurrent diagnostics of all studied patients codified according to the Tenth International Classification of Diseases (ICD-10). Logistic regression analysis was performed to evaluate the influence of the different clinical and epidemiological variables in the evolution of COVID-19 hospitalized patients. Odds ratios were obtained for each variable adjusting by age and sex, and also adjusting by the rest of clinical factors. The software used for analysis was STATA v 16.1. Result(s): 75585 men (55.15%) and 61468 women (44.85%) were hospitalized due to COVID-19 during 2020 in Spain. The median age was 66 in men and 71 in women. Mortality was 14.92% in males, and 13.81% in females. 9.62% of patients were admitted to intensive care unit (ICU). Mortality in ICU was 29.13%. Heart Failure (7.8%), Atrial Fibrillation (7.7%), Pulmonary Embolism (3.46%), Supraventricular Arrythmias (1.18%), Cardiomyopathy (1.06%), Acute Coronary Syndrome (0.87%), Ischemic Stroke (0.33%), Myocarditis (0.12%) Pericarditis (0.06%), or Takotsubo Disease (0.05%), were relevant cardiovascular findings in COVID-19 hospitalized patients (Table 1). In the logistic regression multivariate analysis in COVID-19 patients we found epidemiological predictors of in-hospital mortality such as age (OR 2.38 for each decade), or male sex (OR 1.39). Among the clinical predictors of mortality we differentiated cardiovascular ones as Acute Coronary Syndrome (OR 1.51), Ischemic Stroke (OR 1.46), or Heart Failure (OR 1.43);and non cardiovascular ones such as admission to ICU (OR 3.12), Adult Respiratory Distress Syndrome (OR 2.74), need for Mecanical Ventilation (OR 2.52), Acute Kidney Failure (OR 2.07), Liver damage (OR 1.67), or Dementia (OR 1.66), (Table 2) Conclusion(s): Heart Failure, Pulmonary Embolism, Ischaemic Heart Disease, Atrial fibrillation, Ischemic Stroke, or Cardiomyopathy were among the main cardiovascular diseases associated to COVID-19. They increased in a different measure the risk of mortality in COVID-19, together with factors such as Mecanical ventilation, ICU admission, Acute kidney failure, Dementia, Liver damage, Adult Respiratory Distress Syndrome, older age, or male sex. (Table Presented).

Influence of epidemiological and clinical factors in the reactogenicity to Comirnaty® vaccine in health care workers of a Spanish university teaching hospital (COVIVAC study).

OBJECTIVE: Comirnaty® is an mRNA vaccine against COVID-19 which has been administered to millions of people since the end of 2020. Our aim was to study epidemiological and clinical factors influencing reactogenicity and functional limitation after the first two doses of the vaccine in health care workers (HCWs). METHODS: Prospective post-authorization cohort study to monitor safety and effectiveness of the vaccine. RESULTS: Local side effects were mild and presented both with first and second dose of Comirnaty. Systemic side effects were more frequent after 2nd dose. Nevertheless, previous SARS-CoV-2 infection was associated with systemic effects after the first dose of the vaccine (OR ranging from 2 to 6). No severe adverse effects were reported. According to multivariate analysis, the degree of self-reported functional limitation after the first dose increased with age, female sex, previous COVID-19 contact, previous SARS-CoV-2 infection, and Charlson Comorbidity Index (CCI). After the second dose, the degree of functional limitation observed was lower in those with previous SARS-CoV-2 infection, and it was positively associated to the degree of functional limitation after the first dose. CONCLUSIONS: Systemic adverse effects were more frequent after the second dose of Comirnaty. Previous SARS-CoV-2 infection was associated with systemic effects after the first dose. Age, female sex, previous COVID-19, previous isolation due to COVID-19 contact, and CCI showed to be independent predictors of the degree of functional limitation after the 1st dose of Comirnaty®. After the 2nd dose, the degree of functional limitation was lower in those who previously had SARS-CoV-2 infection.

Burnout syndrome in healthcare workers during COVID-19 pandemic

Background: Coronavirus Disease (COVID-19) exposed health personnel worldwide to high stress levels, which increases the phenomenon of burnout. Aim: To evaluate burnout, its risk, and protective factors in our health team, which has been exposed for months to greater work stress and changes in their usual tasks due to the pandemic. Material and Methods: An online survey including the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and sociodemographic questions, was carried out among health care personnel who continued working during the pandemic. Results: A total of 209 surveys were obtained. Seventy six percent of respondents presented some degree of burnout in the time of the pandemic. Only one protective factor was observed: living with one or more children at home (Odds ratio (OR) 0.21, 95% confidence intervals (CI) 0.05 - 0.87;p = 0.03). Having night shifts (OR 2.72, 95% CI 1.02 - 7.28;p = 0.04), having more than six years in the workplace (OR 3.58, 95% CI 1.18 - 10.8;p = 0.023) and maintaining a regular or poor diet during the pandemic (OR 4.52, 95% CI 1.51-13.48;p < 0.01) were identified as risk factors. Conclusions: A high incidence of burnout was observed in the surveyed population. Living with one or more children in the home stands out as a protective factor and working night shifts, having more than 6 years in the workplace, and maintaining a poor diet as risk factors.

Burnout syndrome in healthcare workers during COVID-19 pandemic

Background: Coronavirus Disease (COVID-19) exposed health personnel worldwide to high stress levels, which increases the phenomenon of burnout. Aim: To evaluate burnout, its risk, and protective factors in our health team, which has been exposed for months to greater work stress and changes in their usual tasks due to the pandemic. Material and Methods: An online survey including the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and sociodemographic questions, was carried out among health care personnel who continued working during the pandemic.

Longitudinal Study after Sputnik V Vaccination Shows Durable SARS-CoV-2 Neutralizing Antibodies and Reduced Viral Variant Escape to Neutralization over Time

Recent studies have shown a temporal increase in the neutralizing antibody potency and breadth to SARS-CoV-2 variants in coronavirus disease 2019 (COVID-19) convalescent individuals. Here, we examined longitudinal antibody responses and viral neutralizing capacity to the B.1 lineage virus (Wuhan related), to variants of concern (VOC;Alpha, Beta, Gamma, and Delta), and to a local variant of interest (VOI;Lambda) in volunteers receiving the Sputnik V vaccine in Argentina. Longitudinal serum samples (N = 536) collected from 118 volunteers obtained between January and October 2021 were used. The analysis indicates that while anti-spike IgG levels significantly wane over time, the neutralizing capacity for the Wuhan-related lineages of SARS-CoV-2 and VOC is maintained within 6 months of vaccination. In addition, an improved antibody cross-neutralizing ability for circulating variants of concern (Beta and Gamma) was observed over time postvaccination. The viral variants that displayed higher escape to neutralizing antibodies with respect to the original virus (Beta and Gamma variants) were the ones showing the largest increase in susceptibility to neutralization over time after vaccination. Our observations indicate that serum neutralizing antibodies are maintained for at least 6 months and show a reduction of VOC escape to neutralizing antibodies over time after vaccination. IMPORTANCE Vaccines have been produced in record time for SARS-CoV-2, offering the possibility of halting the global pandemic However, inequalities in vaccine accessibility in different regions of the world create a need to increase international cooperation. Sputnik V is a recombinant adenovirus-based vaccine that has been widely used in Argentina and other developing countries, but limited information is available about its elicited immune responses. Here, we examined longitudinal antibody levels and viral neutralizing capacity elicited by Sputnik V vaccination. Using a cohort of 118 volunteers, we found that while anti-spike antibodies wane over time, the neutralizing capacity to viral variants of concern and local variants of interest is maintained within 4 months of vaccination. In addition, we observed an increased cross-neutralization activity over time for the Beta and Gamma variants. This study provides valuable information about the immune response generated by a vaccine platform used in many parts of the world.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units☆ Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

[Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU]. / Manejo de las complicaciones infecciosas asociadas con la infección por coronavirus en pacientes graves ingresados en UCI.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.