The Prognostic Impact of Covid-19 in Sepsis: A Population-Based Analysis

ABSTRACT

INTRODUCTION: COVID-19-related organ dysfunction is increasingly recognized as sepsis of viral origin and is a common complication among those requiring hospitalization, with estimated prevalence of over 50% among the latter. However, the population-level association of COVID-19 with short-term mortality among septic patients is unknown. METHOD(S) We used a statewide dataset to identify hospitalizations aged >=18 years with sepsis in Texas during April 1-December 31, 2020. Sepsis was defined by "explicit" and ICD-10 codes for severe sepsis (R65.20) and septic shock (R65.21) and COVID-19 by ICD-10 code U07.1. A hierarchical, mixed-effects model was fit to estimate the association of COVID-19 with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations. Sensitivity analyses of the sepsis hospitalization subsets with septic shock and ICU admission were performed using a similar modeling approach. RESULT(S) Among 55,145 sepsis hospitalizations, 13,149 (23.8%) had COVID-19. Compared to those without COVID-19, sepsis hospitalizations with COVID-19 were younger (aged >=65 years 53.6% vs 55.0%), more commonly male (59.5% vs 50.4%) and racial/ethnic minority (66.1% vs. 46.2%), with lower burden of chronic illness (mean [SD] Charlson comorbidity index 1.8 [1.9] vs 2.8 [2.6]), but with higher mean [SD] number of organ dysfunctions (3.1 [1.4] vs 2.7 [1.6]) [p < 0.0001 for all comparisons]. Short-term mortality among sepsis hospitalizations with and without COVID-19 was 52.7% vs 30.2%, respectively. On adjusted analysis, COVID-19 remained associated with higher risk of short-term mortality (adjusted odds ratio [aOR] 2.54 [95% 2.39-2.70]), with findings on sensitivity analyses consistent with the primary model among sepsis hospitalization subsets with septic shock ([aOR] 2.70 [95% 2.51-2.91]) and ICU admission ([aOR] 2.67 [95% 2.30-3.10]). CONCLUSION(S) COVID-19 infection was associated with over 250% higher odds of short-term mortality among septic patients. Additional studies are needed to determine the mechanisms underlying these observations in order to inform future efforts to reduce the observed outcome disparities.