COVID-19 Increases Mortality Risk in Patients Hospitalized With Sepsis

COVID-19 infection was associated with an increased risk of mortality among critically ill patients hospitalized with sepsis, according to results of a single-center retrospective observational study published in the Journal of Infection and Public Health.

Between February 2020 and March 2021, researchers enrolled adult patients with sepsis who were admitted to an intensive care unit (ICU) at a university hospital in Germany. All patients were screened for COVID-19 infection, and outcomes were compared between those who were vs were not positive for the infection. The primary outcome was in-hospital mortality.

Among patients with sepsis included in the analysis, 177 were positive for COVID-19 infection and 191 were negative. Of patients with and without COVID-19 infection, the mean age was 67 and 65 years, 72% and 72% were men, the mean BMI was 29.0 and 27.0 kg/m² (P <.05), 48% and 53% had bloodstream infections, and the mean Charlson comorbidity score was 3 and 4 (P <0.05), respectively. On ICU admission, septic shock occurred more frequently among patients were negative for COVID-19 infection (43% vs 14%; P <.05).

The most frequently isolated pathogens among patients with vs without COVID-19 infection with bloodstream infections were coagulase-negative staphylococci (26% vs 23%); however, enterococci isolates were less common among those infected with COVID-19 (14% vs 6%). All patients who were infected with COVID-19 required invasive mechanical ventilation (IMV) vs 56% of those without the infection. Of note, systemic inflammation was observed more frequently among patients without COVID-19 infection (P <.05).

Although the median ICU stay was similar among patients who tested positive vs negative for COVID-19 infection (12 vs 15 days), the rate of in-hospital mortality was significantly increased among those with the infection (59% vs 29%; risk ratio [RR], 2.02; 95% CI, 1.57-2.60; P <.05). Only 47% of patients with COVID-19 infection were discharged alive from the ICU compared with 79% of those without the infection (P <.05).

After adjustments for patients’ individual characteristics, the researchers found that COVID-19 infection was significantly associated with in-hospital mortality among patients with sepsis (aRR, 1.74; 95% CI, 1.35-2.24). Other risk factors significantly associated with in-hospital mortality included age, procalcitonin concentration (>2 ng/mL), receipt of kidney replacement therapy, need for IMV, and septic shock on ICU admission.

This study was limited by its observational design and potential selection bias.

According to the researchers, “this study presents several important new findings that are highly relevant for patient care and risk stratification of patients with sepsis with and without COVID-19.”

Reference

Heubner L, Hattenhauer S, Güldner A, et al. Characteristics and outcomes of sepsis patients with and without COVID-19. J Infect Public Health. 2022;15(6):670-676. doi:10.1016/j.jiph.2022.05.008