Characteristics and outcomes of sepsis patients with and without COVID-19

Heubner, Lars; Hattenhauer, Sarah; Güldner, Andreas; Petrick, Paul; Roessler, Martin; Schmitt, Jochen; Schneider, R.; Held, Hanns-Christoph; Mehrholz, Jan; Bodechtel, Ulf; Ragaller, M.; Koch, Thea; Spieth, Peter

doi:10.1016/j.jiph.2022.05.008

Cited by 18 publications

(14 citation statements)

References 43 publications

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“…Since these samples were collected early in the pandemic (between March 2020 to February 2021), the lack of clinical knowledge on appropriate care for these patients may have factored into their more prolonged severe presentations. Furthermore, an ICU clinical cohort study found that sepsis patients with COVID-19 also had higher disease severity than those without ( 28 ). All patients had an initial SOFA score ≥2 and were admitted due to respiratory deterioration suspected to be caused by SARS-CoV-2, thus satisfying both the “organ failure” and “suspected or confirmed infection” criteria of the Sepsis-3 definition.…”

Section: Resultsmentioning

confidence: 99%

Severe COVID-19 and non-COVID-19 severe sepsis converge transcriptionally after a week in the intensive care unit, indicating common disease mechanisms

Baghela

Zhang

et al. 2023

Front. Immunol.

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IntroductionSevere COVID-19 and non-COVID-19 pulmonary sepsis share pathophysiological, immunological, and clinical features. To what extent they share mechanistically-based gene expression trajectories throughout hospitalization was unknown. Our objective was to compare gene expression trajectories between severe COVID-19 patients and contemporaneous non-COVID-19 severe sepsis patients in the intensive care unit (ICU).MethodsIn this prospective single-center observational cohort study, whole blood was drawn from 20 COVID-19 patients and 22 non-COVID-19 adult sepsis patients at two timepoints: ICU admission and approximately a week later. RNA-Seq was performed on whole blood to identify differentially expressed genes and significantly enriched pathways.ResultsAt ICU admission, despite COVID-19 patients being almost clinically indistinguishable from non-COVID-19 sepsis patients, COVID-19 patients had 1,215 differentially expressed genes compared to non-COVID-19 sepsis patients. After one week in the ICU, the number of differentially expressed genes dropped to just 9 genes. This drop coincided with decreased expression of antiviral genes and relatively increased expression of heme metabolism genes over time in COVID-19 patients, eventually reaching expression levels seen in non-COVID-19 sepsis patients. Both groups also had similar underlying immune dysfunction, with upregulation of immune processes such as “Interleukin-1 signaling” and “Interleukin-6/JAK/STAT3 signaling” throughout disease compared to healthy controls.DiscussionEarly on, COVID-19 patients had elevated antiviral responses and suppressed heme metabolism processes compared to non-COVID-19 severe sepsis patients, although both had similar underlying immune dysfunction. However, after one week in the ICU, these diseases became indistinguishable on a gene expression level. These findings highlight the importance of early antiviral treatment for COVID-19, the potential for heme-related therapeutics, and consideration of immunomodulatory therapies for both diseases to treat shared immune dysfunction.

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Section: Resultsmentioning

confidence: 99%

Severe COVID-19 and non-COVID-19 severe sepsis converge transcriptionally after a week in the intensive care unit, indicating common disease mechanisms

Baghela

Zhang

et al. 2023

Front. Immunol.

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“…COVID-19 patients can exhibit lung damage with low oxygenation index, often leading to acute hypoxic respiratory failure, with small percentages of patients have higher risk of in-hospital mortality [ 14 , 15 ]. In addition, sepsis also occurred in hospitalized patients with severe cases of COVID-19 [ 18 , 27 ]. In patients with COVID-19, sepsis is associated with a high in-hospital mortality [ 19 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

A command centre implementation before and during the COVID-19 pandemic in a community hospital

Grosman-Rimon,

Wegier,

Rodriguez

et al. 2024

BMC Med Inform Decis Mak

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Introduction The objective of the study was to assess the effects of high-reliability system by implementing a command centre (CC) on clinical outcomes in a community hospital before and during COVID-19 pandemic from the year 2016 to 2021. Methods A descriptive, retrospective study was conducted at an acute care community hospital. The administrative data included monthly average admissions, intensive care unit (ICU) admissions, average length of stay, total ICU length of stay, and in-hospital mortality. In-hospital acquired events were recorded and defined as one of the following: cardiac arrest, cerebral infarction, respiratory arrest, or sepsis after hospital admissions. A subgroup statistical analysis of patients with in-hospital acquired events was performed. In addition, a subgroup statistical analysis was performed for the department of medicine. Results The rates of in-hospital acquired events and in-hospital mortality among all admitted patients did not change significantly throughout the years 2016 to 2021. In the subgroup of patients with in-hospital acquired events, the in-hospital mortality rate also did not change during the years of the study, despite the increase in the ICU admissions during the COVID-19 pandemic.Although the in-hospital mortality rate did not increase for all admitted patients, the in-hospital mortality rate increased in the department of medicine. Conclusion Implementation of CC and centralized management systems has the potential to improve quality of care by supporting early identification and real-time management of patients at risk of harm and clinical deterioration, including COVID-19 patients.

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“…There are different studies on patients in ICU with a mortality rate of 59% in COVID-19 sepsis vs. 29% in the same period without COVID-19, or 58.7% vs. 40%, respectively ( 24 , 25 ). Our data show that in ICU patients, there was an increase in the 30-day mortality rate from 2018 to 2020, with a reduction in 2021 and a return to mortality values in the pre-COVID-19 era.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance in intensive care patients hospitalized with SEPSIS: a comparison between the COVID-19 pandemic and pre-pandemic era

Falasca,

Vetrugno,

Borrelli

et al. 2024

Front. Med.

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IntroductionCoronavirus disease 2019 (COVID-19) is a highly contagious viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has had a dramatic effect on the world, resulting in millions of deaths worldwide and causing drastic changes in daily life. A study reported that septic complications were associated with high mortality in COVID-19 patients. This study aimed to evaluate how the COVID-19 pandemic changed the pre-pandemic and post-pandemic prevalence of sepsis in ICUs and to evaluate the different risk factors associated with mortality and the different diffusion of microorganisms and their resistance.Materials and methodsWe conducted a single-center retrospective observational clinical study, observing all patients in the ICU of the SS Annunziata Hospital in Chieti (Italy) who were diagnosed with sepsis and had a bacterial isolate from their blood culture. Sepsis was diagnosed by SEPSIIS III criteria. We enrolled all in-patients in the ICU from January 2018 to December 2021. We divided the patients into three groups: (1) non-pandemic period (Np) hospitalized in 2018–2019, (2) pandemic period (Pp)-COVID hospitalized in 2020–2021 with a diagnosis of COVID-19, and (3) Pp-non-COVID patients hospitalized in 2020–2021 without a diagnosis of COVID-19.ResultsFrom January 2018 to December 2021, 1,559 patients were admitted to the ICU, of which 211 patients [36 (17.1%) in 2018, 52 (24.6%) in 2019, 73 (34.6%) in 2020, and 50 (23.7%) in 2021, respectively] met the selection criteria: 88 patients in period Np, 67 patients in Pp without COVID-19, and 56 patients Pp with COVID-19. The overall mortality of these patients was high (65.9% at 30 days in Np), but decreased during the Pp (60.9%): Pp-non-COVID was 56.7% vs. Pp-COVID 66.1%, with a statistically significant association with APACHE III score (OR 1.08, 95%CI 1.04–1.12, p < 0.001), SOFA score (OR 1.12, 95%CI 1.03–1.22, p = 0.004), and age (OR 1.04, 95%CI 1.02–1.07, p < 0.0001). Between the Np vs. Pp periods, we observed an increase in a few Gram-positive bacteria such as S. capitis (1 pt. −0.9% vs. 14 pt. −7.65%- p = 0.008), S. epidermidis, Streptococcus spp., and E. faecalis, as well as a decrease in a case of blood culture positive for S. aureus, S. hominis, and E. faecium. In Gram-negative bacteria, we observed an increase in cases of Acinetobacter spp. (Np 6 pt. −5.1%- vs. Pp 20 pt. −10.9%, p = 0.082), and Serratia spp., while cases of sepsis decreased from E. faecium (Np 11 pt. −9.4%- vs. Pp 7 pt. −3.8%, p = 0.047), and Enterobacter spp., S. haemolyticus, S. maltophilia, Proteus spp., and P. aeruginosa have not changed. Finally, we found that resistance to OXA-48 (p = 0.040), ESBL (p = 0.002), carbapenems (p = 0.050), and colistin (p = 0.003) decreased with time from Np to Pp, particularly in Pp-COVID.ConclusionThis study demonstrated how the COVID-19 pandemic changed the prevalence of sepsis in the ICU. It emerged that the risk factors associated with mortality were APACHE and SOFA scores, age, and, above all, the presence of ESBL-producing bacteria. Despite this, during the pandemic phase, we have observed a significant reduction in the emergence of resistant germs compared to the pre-pandemic phase.

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Characteristics and outcomes of sepsis patients with and without COVID-19

Cited by 18 publications

References 43 publications

Severe COVID-19 and non-COVID-19 severe sepsis converge transcriptionally after a week in the intensive care unit, indicating common disease mechanisms

Severe COVID-19 and non-COVID-19 severe sepsis converge transcriptionally after a week in the intensive care unit, indicating common disease mechanisms

A command centre implementation before and during the COVID-19 pandemic in a community hospital

Antimicrobial resistance in intensive care patients hospitalized with SEPSIS: a comparison between the COVID-19 pandemic and pre-pandemic era

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