Sepsis associated with COVID-19 infections more common than thought

Today in JAMA Network Open, researchers provide new evidence that the prevalence of SARS-CoV-2–associated sepsis among hospitalized adults is higher than previously thought, but deaths from the condition became less frequent as the pandemic progressed.

The study is based on records of adults admitted to one of five Massachusetts hospitals from March 2020 to November 2022. A total of 431,017 hospital encounters from 261,595 individuals were included in the study.

A total of 23,276 patients (5.4%) were hospitalized for SARS-CoV-2, 6,558 (1.5%) had SARS-CoV-2–associated sepsis, and 30,604 patients (7.1%) had presumed bacterial sepsis without SARS-CoV-2 infection.

SARS-CoV-2–associated sepsis was defined as a positive SARS-CoV-2 test and concurrent organ dysfunction. The most common organ dysfunctions for SARS-CoV-2–associated sepsis were respiratory distress and failure requiring more than a nasal cannula, seen in 82.2% of patients.

Mortality for COVID-related sepsis dropped

Crude in-hospital mortality for SARS-CoV-2–associated sepsis was 1,460 of 558 patients (22.3%) overall, and crude mortality for presumed bacterial sepsis was 4,451 of 30,604 (14.5%), the authors said.

The incidence of SARS-CoV-2–associated sepsis fluctuated in tandem with changes in local community incidence.

The 14.5% remained consistent across the study period, but the crude mortality rate due to SARS-CoV-2–associated sepsis dropped from 490 of 1,469 (33.4%) in the first quarter of the study to 67 of 450 (14.9%) in the last (adjusted odds ratio, 0.88 [95% confidence interval [CI], 0.85 to 0.90] per quarter).

Overall, SARS-CoV-2–associated sepsis was present in 28.2% of patients admitted with SARS-CoV-2.

“The incidence of SARS-CoV-2–associated sepsis fluctuated in tandem with changes in local community incidence but trended toward fewer cases between the pandemic onset and November 2022,” the authors said. “In-hospital mortality rates were initially high for SARS-CoV-2–associated sepsis (33.4%) but decreased to 14.9% by November 2022.”