Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19.
Prevalence, Clinical Characteristics, and Outcomes of Sepsis Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Versus Other Pathogens in Hospitalized Patients With COVID-19.
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DOI：
10.1097/cce.0000000000000703
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发表时间：
2022-05
影响因子：
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通讯作者：
Rhee, Chanu
中科院分区：
文献类型：
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作者：
Shappell, Claire N.;Klompas, Michael;Kanjilal, Sanjat;Chan, Christina;Rhee, Chanu
COVID-19 住院患者败血症的患病率和原因尚不清楚。旨在调查 COVID-19 住院患者中由严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 与其他病原体引起的脓毒症的患病率、临床特征和结果。对 2020 年 3 月至 2021 年 3 月期间在马萨诸塞州四家医院住院的 200 名随机选择的 COVID-19 患者进行横断面回顾性图表审查。根据 Sepsis-3 标准确定是否存在脓毒症（感染导致序贯器官衰竭评估评分比基线增加 ≥ 2 分）。脓毒症发作被评估为由 SARS-CoV-2、其他病原体或两者引起。还评估了器官功能障碍和院内死亡率。 200 例 COVID-19 住院治疗中，有 65 例（32.5%）出现脓毒症，其中 65 例脓毒症发作中，有 46 例（70.8%）仅由 SARS-CoV-2 引起，65 例脓毒症发作中，有 17 例（26.2%）由 SARS-CoV-2 和非 SARS-CoV-2 感染引起，65 例脓毒症中有 2 例（3.1%）仅由细菌感染引起。脓毒症患者中与 SARS-CoV-2 相关的器官功能障碍平均发生在入院后 1 天（四分位距，0-2 天），最常表现为呼吸功能障碍 (93.7%)、神经系统功能障碍 (46.0%) 和/或肾功能障碍 (39.7%)。 200 例 COVID-19 住院患者中，有 28 例（14.0%）发生院内死亡，其中 135 例无脓毒症患者中有 2 例（1.5%），46 例仅因 SARS-CoV-2 引起脓毒症的患者中有 16 例（34.8%），以及 17 例因 SARS-CoV-2 和细菌病原体同时引起脓毒症的患者中有 10 例（58.8%）。三分之一的因 COVID-19 住院的患者发生脓毒症，主要由 SARS-CoV-2 本身引起，尽管细菌感染也导致了四分之一的脓毒症病例。患有脓毒症的 COVID-19 患者的死亡率很高，尤其是混合患有 SARS-CoV-2 和细菌性脓毒症的患者。这些发现证实 SARS-CoV-2 是脓毒症的一个重要原因，并强调需要改进对住院的 COVID-19 患者的病毒性和细菌性脓毒症的监测、识别、预防和治疗。
The prevalence and causes of sepsis in patients hospitalized with COVID-19 are poorly characterized. To investigate the prevalence, clinical characteristics, and outcomes of sepsis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) versus other pathogens in patients hospitalized with COVID-19. Cross-sectional, retrospective chart review of 200 randomly selected patients hospitalized with COVID-19 at four Massachusetts hospitals between March 2020 and March 2021. The presence or absence of sepsis was determined per Sepsis-3 criteria (infection leading to an increase in Sequential Organ Failure Assessment score by ≥ 2 points above baseline). Sepsis episodes were assessed as caused by SARS-CoV-2, other pathogens, or both. Rates of organ dysfunction and in-hospital death were also assessed. Sepsis was present in 65 of 200 COVID-19 hospitalizations (32.5%), of which 46 of 65 sepsis episodes (70.8%) were due to SARS-CoV-2 alone, 17 of 65 (26.2%) were due to both SARS-CoV-2 and non-SARS-CoV-2 infections, and two of 65 (3.1%) were due to bacterial infection alone. SARS-CoV-2–related organ dysfunction in patients with sepsis occurred a median of 1 day after admission (interquartile range, 0–2 d) and most often presented as respiratory (93.7%), neurologic (46.0%), and/or renal (39.7%) dysfunctions. In-hospital death occurred in 28 of 200 COVID-19 hospitalizations (14.0%), including two of 135 patients without sepsis (1.5%), 16 of 46 patients with sepsis (34.8%) due to SARS-CoV-2 alone, and 10 of 17 patients with sepsis (58.8%) due to both SARS-CoV-2 and bacterial pathogens. Sepsis occurred in one in three patients hospitalized with COVID-19 and was primarily caused by SARS-CoV-2 itself, although bacterial infection also contributed in a quarter of sepsis cases. Mortality in COVID-19 patients with sepsis was high, especially in patients with mixed SARS-CoV-2 and bacterial sepsis. These findings affirm SARS-CoV-2 as an important cause of sepsis and highlight the need to improve surveillance, recognition, prevention, and treatment of both viral and bacterial sepsis in hospitalized patients with COVID-19.