COVID-19 virus was more common cause of sepsis than previously assumed

Emerging research reveals that the virus responsible for COVID-19 played a more significant and lethal role in causing sepsis during the early stages of the pandemic than previously believed.

Conducted by a team from Brigham and Women’s Hospital, part of the Mass General Brigham healthcare system, this study employed electronic health records from five hospitals within the system to monitor the incidence of SARS-CoV-2-associated sepsis during the COVID-19 outbreak. Surprisingly, the study found that SARS-CoV-2 contributed to roughly one out of every six cases of sepsis during the pandemic’s initial two and a half years.

Published in JAMA Network Open, these findings urge healthcare providers to reconsider their approach to sepsis treatment and establish a foundation for tracking viral sepsis in the future.

Dr. Claire Shappell, the lead author of the study, explained, “Most individuals, including healthcare professionals, commonly associate sepsis with bacterial infections. Current treatment guidelines and quality measures emphasize the immediate administration of antibiotics for suspected sepsis. However, viral infections, such as the SARS-CoV-2 virus responsible for COVID-19, can trigger the same dysfunctional immune response leading to organ failure, similar to bacterial sepsis.”

Previous studies on viral sepsis had limitations, prompting the team to leverage electronic health records from Mass General Brigham hospitals for a more comprehensive view of sepsis cases.

Senior author Chanu Rhee emphasized, “Past attempts to quantify the impact of SARS-CoV-2-associated sepsis were hindered by inconsistent definitions and a failure to recognize viral sepsis. Our prior research demonstrated that electronic health record-based surveillance provides more precise estimates of sepsis incidence and outcomes compared to administrative datasets. However, this approach had not been previously applied specifically to sepsis linked to SARS-CoV-2 or other viruses.”

To calculate the incidence and mortality of SARS-CoV-2-associated sepsis, the team used clinical criteria adapted from the Center for Disease Control and Prevention’s sepsis surveillance definition, considering both positive SARS-CoV-2 tests and clinical signs of organ dysfunction.

Between March 2020 and November 2022, the researchers identified 431,017 hospitalizations from 261,595 individuals. During this period, 5.4% of hospitalizations resulted from SARS-CoV-2 infections, with 28.2% of these cases associated with SARS-CoV-2-related sepsis.

Initially, patients with SARS-CoV-2-associated sepsis faced a high mortality rate—33% during the first three months of the pandemic. However, this rate decreased over time and eventually became similar to the mortality rate for presumed bacterial sepsis, stabilizing at approximately 14.5% throughout the study. Importantly, the researchers confirmed that their electronic surveillance definition accurately identified cases of viral sepsis caused by SARS-CoV-2 infections using the Mass General Brigham electronic health record dataset.

The study’s design, relying on electronic health records, offers a blueprint for future investigations into sepsis linked to other viruses, such as influenza and respiratory syncytial virus (RSV). The team aspires to apply this methodology to larger, nationally representative datasets to provide broader epidemiological insights into viral sepsis.

Dr. Shappell summarized, “Our study underscores the substantial burden and poor outcomes associated with viral sepsis, while demonstrating the effectiveness of using electronic health record-based algorithms for surveillance of both viral and bacterial sepsis. We also hope these findings emphasize that sepsis is not a one-size-fits-all condition but one that necessitates clinicians tailoring their diagnosis and treatment strategy to each patient’s syndrome and likely pathogen.”

Source: Brigham and Women’s Hospital

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