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. 2022 May 13;4(5):e0703.
doi: 10.1097/CCE.0000000000000703. eCollection 2022 May.

Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19

Claire N Shappell  1   2 , Michael Klompas  1   3 , Sanjat Kanjilal  1   3 , Christina Chan  1 , Chanu Rhee  1   3
Affiliations

Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19

Claire N Shappell et al. Crit Care Explor. .

Abstract

The prevalence and causes of sepsis in patients hospitalized with COVID-19 are poorly characterized.

Objectives: To investigate the prevalence, clinical characteristics, and outcomes of sepsis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) versus other pathogens in patients hospitalized with COVID-19.

Design setting and participants: Cross-sectional, retrospective chart review of 200 randomly selected patients hospitalized with COVID-19 at four Massachusetts hospitals between March 2020 and March 2021.

Main outcomes and measures: The presence or absence of sepsis was determined per Sepsis-3 criteria (infection leading to an increase in Sequential Organ Failure Assessment score by ≥ 2 points above baseline). Sepsis episodes were assessed as caused by SARS-CoV-2, other pathogens, or both. Rates of organ dysfunction and in-hospital death were also assessed.

Results: Sepsis was present in 65 of 200 COVID-19 hospitalizations (32.5%), of which 46 of 65 sepsis episodes (70.8%) were due to SARS-CoV-2 alone, 17 of 65 (26.2%) were due to both SARS-CoV-2 and non-SARS-CoV-2 infections, and two of 65 (3.1%) were due to bacterial infection alone. SARS-CoV-2-related organ dysfunction in patients with sepsis occurred a median of 1 day after admission (interquartile range, 0-2 d) and most often presented as respiratory (93.7%), neurologic (46.0%), and/or renal (39.7%) dysfunctions. In-hospital death occurred in 28 of 200 COVID-19 hospitalizations (14.0%), including two of 135 patients without sepsis (1.5%), 16 of 46 patients with sepsis (34.8%) due to SARS-CoV-2 alone, and 10 of 17 patients with sepsis (58.8%) due to both SARS-CoV-2 and bacterial pathogens.

Conclusions: Sepsis occurred in one in three patients hospitalized with COVID-19 and was primarily caused by SARS-CoV-2 itself, although bacterial infection also contributed in a quarter of sepsis cases. Mortality in COVID-19 patients with sepsis was high, especially in patients with mixed SARS-CoV-2 and bacterial sepsis. These findings affirm SARS-CoV-2 as an important cause of sepsis and highlight the need to improve surveillance, recognition, prevention, and treatment of both viral and bacterial sepsis in hospitalized patients with COVID-19.

Keywords: COVID-19; organ dysfunction; sepsis; severe acute respiratory syndrome coronavirus 2; viral sepsis.

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Conflict of interest statement

Drs. Klompas and Rhee report royalties from UpToDate. Dr. Rhee also reports consulting fees from Pfizer and Cytovale for work unrelated to this topic. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart summarizing distribution of sepsis cases in patients hospitalized with COVID-19. SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Prevalence and case fatality rates for sepsis related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other infections among patients hospitalized with COVID-19.
See this image and copyright information in PMC

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