Study Spanning Early Pandemic Points To Importance Of Viral Sepsis

New research has underscored the importance of monitoring for sepsis in individuals hospitalized with, or because of, COVID-19. More broadly, the work underlines the need for sepsis surveillance strategies that take viral forms of sepsis into account.

“Our study draws attention to the high burden and poor outcomes associated with viral sepsis,” Claire Shappell, a researcher with the Brigham and Women’s Hospital (BWH) pulmonary and critical care medicine division, said in a news release issued by BWH today. “We also hope 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.”

Looking back at electronic health record (EHR) data from five community or academic acute care hospitals in Massachusetts over close to three years, Shappell and her colleagues at BWH and Harvard Medical School flagged patients who showed signs of organ dysfunction after testing positive for SARS-CoV-2 on a polymerase chain reaction test.

They then set those cases of SARS-CoV-2-associated sepsis against cases of bacterial sepsis in adult patients, demonstrating that the coronavirus contributed to a significant proportion of sepsis cases identified.

“Electronic health record-based surveillance using clinical markers of concurrent infection and organ dysfunction is rapidly becoming the state-of-the-art method for widescale sepsis surveillance,” Shappell and her colleagues wrote in a study published in JAMA Network Open today.

The authors noted that the approach “is particularly well-suited to describe trends in sepsis incidence, characteristics, and outcomes when perceptions of what constitutes sepsis and clinicians’ proclivity to diagnose sepsis are changing.”

Generally speaking, sepsis encompasses a range of infection-related organ dysfunction features that can become extremely serious or deadly the investigators explained, noting that viral sepsis diagnoses have traditionally been quite rare compared to forms of sepsis stemming from bacteria.

Still, they noted that hints from patients with SARS-CoV-2, influenza, or respiratory syncytial virus have prompted investigators to take a closer look at potential viral roles in sepsis, which has been linked to everything from death and disability to ballooning health care costs.

Based on electronic health record (EHR) data for nearly 261,600 patients who collectively had more than 431,000 hospital encounters between March of 2020 and November, 2022, the team tracked down 23,276 SARS-CoV-2-related hospital encounters, flagging 6,558 encounters involving SARS-CoV-2-associated sepsis.

“Our prior research has shown that EHR-based surveillance can provide more accurate estimates of sepsis incidence and outcomes compared to administrative datasets,” senior author Chanu Rhee, head of the infectious diseases division at BWH, said in today’s statement from BWH, “but this method had not previously been applied specifically for sepsis associated with SARS-CoV-2 or other viruses.”

While mortality rates for SARS-CoV-2-associated sepsis declined over time, they were still relatively high. In the first quarter considered, SARS-CoV-2-associated mortality came in at 33.4 percent, the researchers reported, noting that the final quarter saw mortality rates coming in at 14.9 percent in the SARS-CoV-2-associated sepsis group.

In contrast, the team saw bacterial sepsis diagnoses in just over 30,600 COVID-19-free individuals, representing roughly 7 percent of patients included in the retrospective study. The average mortality rate in patients with bacterial sepsis was 14.5 percent, and remained consistent across the time points included in the study.

Based on their findings, the investigators estimated that around one in six sepsis cases found at the hospitals they considered over the first 33 months of COVID-19 had ties to SARS-CoV-2 infection.

Consequently, study’s authors pointed to the importance of watching for viral sepsis in individuals hospitalized for SARS-CoV-2 infections, while considering potential viral culprits in patients who have already developed the complication.

“Most people, including medical professionals, equate sepsis with bacterial infections,” lead author Shappell explained. “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.”