Large study links many cases of sepsis to SARS-CoV-2 infection
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Key takeaways:
- One in six cases of sepsis during the first 33 months of the COVID-19 pandemic was related to SARS-CoV-2 infection.
- Electronic health records can be used to conduct surveillance for viral sepsis.
SARS-CoV-2 infection accounted for roughly one in six cases of sepsis at five Massachusetts hospitals during the first 33 months of the COVID-19 pandemic, according to findings from a large study of more than 430,000 patient encounters.
The findings, reported in JAMA Network Open, “highlight the high burden of SARS-CoV-2–associated sepsis and demonstrate the feasibility of using EHR-based algorithms to conduct surveillance for viral sepsis," the researchers wrote.
“Previous efforts to quantify the burden of SARS-CoV-2-associated sepsis have been limited by inconsistent definitions and underrecognition of viral sepsis,” Chanu Rhee, MD, MPH, associate hospital epidemiologist at Brigham and Women’s Hospital in Boston, said in a press release.
Roughly 1.7 million adults in the United States develop sepsis each year, and at least 350,000 either die during hospitalization or are discharged to hospice, according to the CDC, which launched an anti-sepsis program for U.S. hospitals in August.
Sepsis has historically been linked to bacterial infection, with most studies reporting few or no cases of viral sepsis — “likely a function of underrecognition and undertesting rather than the absence of viral sepsis,” Rhee and colleagues wrote.
“Most people, including medical professionals, equate sepsis with bacterial infections,” Claire N. Shappell, MD, MPH, a pulmonologist at Brigham and Women’s Hospital, said in the release.
“This is reflected in treatment guidelines and quality measures that require immediate antibiotics for patients with suspected sepsis. However, viral infections, including the SARS-CoV-2 virus that causes COVID-19, can trigger the same dysregulated immune response that leads to organ dysfunction as in bacterial sepsis,” Shappell said.
Shappell and colleagues performed a retrospective analysis of electronic health record data for more than 431,000 adults hospitalized at five hospitals in the Mass General Brigham health care system between March 1, 2020, and Nov. 30, 2022.
Of these hospital encounters, 5.4% were for SARS-CoV-2 infection, 1.5% had SARS-CoV-2-associated sepsis and 7.1% had presumed bacterial sepsis without SARS-CoV-2 infection, according to the study. Among SARS-CoV-2-positive hospitalizations, 28.2% were diagnosed with SARS-CoV-2-associated sepsis.
During the study period, crude in-hospital mortality for SARS-CoV-2-associated sepsis declined from 33.4% in the first quarter of the study period to 14.9% in the last quarter. In comparison, the crude mortality rate for presumed bacterial sepsis remained stable throughout the study period at 14.5%.
Shappell said the hope is that “our findings highlight that sepsis is not a ‘one-size-fits-all’ entity, but one that requires clinicians to tailor their diagnosis and treatment strategy to each patient’s syndrome and probable pathogen.”
References:
Shappell CN, et al. JAMA Network Open. 2023;doi:10.1001/jamanetworkopen.2023.35728.
Study finds SARS-CoV-2-associated sepsis was more common, deadly than previously thought. https://www.brighamandwomens.org/about-bwh/newsroom/for-the-media. Accessed Sept. 29, 2023.
Patient safety: Get ahead of sepsis — know the risks. Spot the signs. Act fast. https://www.cdc.gov/patientsafety/features/get-ahead-of-sepsis.html. Updated Sept. 11, 2023. Accessed Sept. 28, 2023.
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