Comparative Evaluation of the Prognosis of Septic Shock Patients from Before to After the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis

Abstract

In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the ED of a tertiary medical center in South Korea from February 2019 to February 2021. Following the COVID-19 pandemic onset, revised institutional ED processes included a stringent isolation protocol for patients visiting the ED. The primary goal of this study was to determine the mortality rate of septic shock patients from before and after the onset of the COVID-19 pandemic. Durations of vasopressor use, mechanical ventilation, intensive care unit stay, and hospitalization were investigated. The mortality rates increased from 24.8% to 35.8%, before and after COVID-19-onset, but the difference was not statistically significant (p = 0.079). No significant differences in other outcomes were found. Multivariable analysis revealed that the Simplified Acute Physiology Score III (SAPS III) was the only risk factor for mortality (OR 1.07; 95% CI 1.04-1.10), whereas COVID-19 pandemic was not included in the final model. The non-significant influence of the COVID-19 pandemic on septic shock mortality rates in the present study belies the actual mortality-influencing potential of the COVID-19 pandemic.

Keywords: COVID-19; coronavirus; emergency department; mortality; sepsis; septic shock.

Figure 1

Clinical algorithm for patients visiting the ED, and a picture of an ED worker wearing PPE after the COVID-19 pandemic. A star (*) indicates changes in the process, and a double star (**) indicates an addition in the process with regard to the previous clinical pathway. (A) Clinical pathway. (B) ED worker wearing PPE. Acronyms: ED, emergency department; COVID-19, coronavirus disease; EM, emergency medicine; NPIR, negative pressure isolation room; RT-PCR, reverse transcription-polymerase chain reaction; ICU, intensive care unit; ER; emergency room; and PPE; personal protective equipment.

Figure 2

Flow chart of patients enrolled from the NEDIS. Acronyms: NEDIS, National Emergency Department Information System; COVID-19, coronavirus disease; and ER, emergency room.

Figure 3

Independent predictors of in-hospital mortality for septic shock patients. Sex, age, time from onset of initial symptoms to ED arrival, time from arrival to administration of antibiotics, the SAPS III, and the pre-COVID-19 and post-COVID-19-onset periods were adjusted. The final model included the following potential risk factors: sex and the SAPS III. Error bars indicate 95% confidence interval and red dots indicates odds ratio. Acronyms: COVID-19, coronavirus disease; and SAPS, Simplified Acute Physiology Score III.