COVID-19 as cause of viral sepsis: A Systematic Review and Meta-Analysis

Abstract

ImportanceCOVID-19 is a heterogenous disease most frequently causing respiratory tract infection but in its severe forms, respiratory failure and multiple organ dysfunction syndrome may occur, resembling sepsis. The prevalence of viral sepsis among COVID-19 patients is still unclear.ObjectiveWe aimed to describe this in a systematic review.Data sourcesMEDLINE(PubMed), Cochrane and Google Scholar databases were searched for studies reporting on patients hospitalized with confirmed COVID-19, diagnosed with sepsis or infection-related organ dysfunctions or receiving organ replacement therapy.Study selectionEligible were full-text English articles of randomized and non-randomized clinical trials and observational studies reporting on patients with confirmed COVID-19, who are diagnosed with sepsis or have infection-related organ dysfunctions. Systematic reviews, editorials, conference abstracts, animal studies, case reports, articles neither in English nor full-text, and studies with fewer than 30 participants were excluded.Data extraction and synthesisAll eligible studies were included in a narrative synthesis of results and after reviewing all included studies a meta-analysis was conducted. Separate sensitivity analyses were conducted per adult vs pediatric populations and per Intensive Care Unit (ICU) vs non-ICU populations.Main outcomes and measuresPrimary endpoint was the prevalence of sepsis using Sepsis-3 criteria among patients with COVID-19 and among secondary, new onset of infection-related organ dysfunction. Outcomes were expressed as proportions with respective 95% confidence interval (CI).ResultsOf 1,903 articles, 104 were analyzed. The prevalence of sepsis in COVID-19 was 39.9% (95% CI, 35.9-44.1; I2, 99%). In sensitivity analysis, sepsis was present in 25.1% (95% CI, 21.8-28.9; I2 99%) of adult patients hospitalized in non-Intensive-Care-Unit (ICU) wards (40 studies) and in 83.8 (95% CI, 78.1-88.2; I2,91%) of adult patients hospitalized in the ICU (31 studies). Sepsis in children hospitalized with COVID-19 was as high as 7.8% (95% CI, 0.4-64.9; I2, 97%). Acute Respiratory Distress Syndrome was the most common organ dysfunction in adult patients in non-ICU (27.6; 95% CI, 21.6-34.5; I2, 99%) and ICU (88.3%; 95% CI, 79.7-93.5; I2, 97%)Conclusions and relevanceDespite the high heterogeneity in reported results, sepsis frequently complicates COVID-19 among hospitalized patients and is significantly higher among those in the ICU. PROSPERO registration number: CRD42020202018. No funding.KEY POINTSQuestionWhat is the prevalence of viral sepsis by Sepsis-3 definition among hospitalized patients with COVID-19?FindingsIn this systematic review and meta-analysis, we systematically reviewed published literature for evidence of organ failure in COVID-19, to estimate the prevalence of viral sepsis in this setting, by means of SOFA score calculation. The prevalence of sepsis in COVID-19 was 39.9% (95% CI, 35.9-44.1; I2, 99%).MeaningThis is the first study to address the burden of viral sepsis in hospitalized patients with COVID-19, a highly heterogenous infection ranging from asymptomatic cases to severe disease leading to death, as reflected in the high heterogeneity of this study.

Epidemiology and Costs of Postsepsis Morbidity, Nursing Care Dependency, and Mortality in Germany, 2013 to 2017

“…Sepsis is a frequent complication in patients with COVID-19 treated in the ICU and not treated in the ICU. 35 In a cohort of patients discharged from the hospital, 76% had 1 or more residual symptom at 6 months, including fatigue/muscle weakness (63%), sleep problems (23%), and anxiety or depression (23%). 36 Furthermore, our findings demonstrate that new medical, psychological, and cognitive diagnoses consistent with postsepsis morbidity are also common among patients who fulfil the criteria of nonsevere sepsis according to the old sepsis 1 and sepsis 2 criteria.…”

Genetic variants in the NF-κB signaling pathway (NFKB1, NFKBIA, NFKBIZ) and risk of critical outcome among COVID-19 patients

“…The clinical manifestations of this disease range from asymptomatic forms that do not require hospitalization to severe illness with ICU admission and high risk of mortality [2] . Many of COVID-19 severe complications are explained by an exacerbated inflammatory response (cytokine storm) that leads to acute lung injury and acute respiratory distress syndrome, and to multiple organ dysfunction at a systemic level, resembling a septic process [3] , [4] , [5] , [6] . In addition to well recognized risk factors such as advanced age, male sex and hypertension, the genetic background of the host has been widely associated with the risk of developing severe COVID-19.…”

White Paper – Verbesserung der Versorgungs- und Behandlungsangebote für Menschen mit Sepsis- und Infektionsfolgen

“…Dies wird insbesondere aktuell bei COVID-19 als sepsisauslösender Infektion deutlich. Etwa 33 % der Corona-Infektionen auf Nichtintensivstationen gehen mit einer Sepsis einher, auf Intensivstationen sogar 78 % [7]. Folgen nach COVID-Infektionen sind in Art und Häufigkeit den Folgen von Sepsis durch andere Erreger ähnlich [8] und treten auch bei leichteren COVID-19-Verläufen auf [9].…”