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. 2022 Nov 1;12(11):1803.
doi: 10.3390/jpm12111803.

Impact of COVID-19 Pandemic on Management and Outcomes in Patients with Septic Shock in the Emergency Department

Daun Jeong  1 , Gun Tak Lee  1 , Jong Eun Park  1 , Tae Gun Shin  1 , Kyunga Kim  2   3 , Doeun Jang  3 , Won Young Kim  4 , You Hwan Jo  5 , Sung Phil Chung  6 , Jin Ho Beom  6 , Sung-Hyuk Choi  7 , Woon Yong Kwon  8 , Gil Joon Suh  8 , Byuk Sung Ko  9 , Kap Su Han  10 , Jong Hwan Shin  11 , Hanjin Cho  12 , Korean Shock Society KoSS Investigators, Sung Yeon Hwang  1
Affiliations

Impact of COVID-19 Pandemic on Management and Outcomes in Patients with Septic Shock in the Emergency Department

Daun Jeong et al. J Pers Med. .

Abstract

This study aimed to determine the impact of modifications in emergency department (ED) practices caused by the coronavirus disease 2019 (COVID-19) pandemic on the clinical outcomes and management of patients with septic shock. We performed a retrospective study. Patients with septic shock who presented to the ED between 1 January 2018 and 19 January 2020 were allocated to the pre-COVID-19 group, whereas those who presented between 20 January 2020 and 31 December 2020 were assigned to the post-COVID-19 group. We used propensity score matching to compare the sepsis-related interventions and clinical outcomes. The primary outcome measure was in-hospital mortality. Of the 3697 patients included, 2254 were classified as pre-COVID-19 and 1143 as post-COVID-19. A total of 1140 propensity score-matched pairings were created. Overall, the in-hospital mortality rate was 25.5%, with no statistical difference between the pre- and post-COVID-19 groups (p = 0.92). In a matched cohort, the post-COVID-19 group had delayed lactate measurement, blood culture test, and infection source control (all p < 0.05). There was no significant difference in time to antibiotics (p = 0.19) or vasopressor administration (p = 0.09) between the groups. Although sepsis-related interventions were delayed during the COVID-19 pandemic, there was no significant difference in the in-hospital mortality between the pre- and post-COVID-19 groups.

Keywords: COVID-19; mortality; resuscitation; sepsis bundle; septic shock.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart. KoSS, Korean Shock Society; COVID-19, coronavirus disease 2019.
Figure 2
Figure 2
Propensity-matched cohort analysis of time interval from triage to sepsis shock-related intervention. The median time to lactate measurement in the pre-COVID-19 group and post-COVID-19 group was 27.0 min [IQR 14.0–60.0] and 37.0 min [IQR 20.0–77.0] (p < 0.05). The median time to blood culture in the pre-COVID-19 group and post-COVID-19 groups was 82.0 min [IQR 34.0–175.0] and 117.0 min [IQR 55.0–205.0] (p < 0.05). The median time to IV antibiotics in the pre-COVID-19 group and post-COVID-19 groups was 140.5 min [IQR 91.0–222.0] and 138.0 min [IQR 84.0–213.0] (p = 0.19). The median time to vasopressor in the pre-COVID-19 group and post-COVID-19 groups was 133.0 min [IQR 68.0–240.0] and 143.5 min [IQR 75.0–253.0] (p = 0.09). The median time to source control in the pre-COVID-19 group and post-COVID-19 groups was 12.9 h [IQR 6.3–27.4] and 16.1 h [IQR 8.6–49.1] (p = 0.01). COVID-19, coronavirus disease 2019; IV, intravenous.
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