Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2–Associated Sepsis

The study titled “Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2–Associated Sepsis,” conducted by Claire N. Shappell and colleagues for the CDC Prevention Epicenters Program, aimed to quantify the burden of SARS-CoV-2–associated sepsis compared to presumed bacterial sepsis using objective electronic clinical criteria​​.

Key aspects of the study include:

  1. Objective and Importance: The study focused on addressing the challenge of quantifying SARS-CoV-2–associated sepsis, hindered by inconsistent definitions and underrecognition of viral sepsis. Its goal was to provide a clear picture of the incidence and outcomes of SARS-CoV-2–associated sepsis versus presumed bacterial sepsis​​.
  2. Design, Setting, and Participants: This retrospective cohort study included adult patients hospitalized in five Massachusetts hospitals from March 2020 to November 2022. SARS-CoV-2–associated sepsis was identified through a positive SARS-CoV-2 test and signs of organ dysfunction, while presumed bacterial sepsis was defined by modified CDC criteria​​.
  3. Main Outcomes and Measures: The study assessed trends in the quarterly incidence (proportion of hospitalizations) and in-hospital mortality for both types of sepsis using negative binomial and logistic regression models​​.
  4. Results: The study encompassed 431,017 hospital encounters, with 23,276 (5.4%) being COVID-19 cases. Among these, 6,558 (1.5% of all admissions) had SARS-CoV-2–associated sepsis, and 30,604 (7.1%) had presumed bacterial sepsis. Initially, in-hospital mortality for SARS-CoV-2–associated sepsis was high (33.4%) but declined to 14.9% over time, aligning with mortality rates for presumed bacterial sepsis (14.5%)​​.
  5. Context and Prior Research: Sepsis, a life-threatening organ dysfunction due to infection, has historically been associated more with bacterial than viral infections. The SARS-CoV-2 pandemic highlighted the significance of viral infections in sepsis incidence and mortality, prompting this study to use advanced electronic health record (EHR)–based surveillance for a more objective and reproducible analysis​​.
  6. Methodology and Validation: The study applied a modified version of the CDC’s adult sepsis event criteria to define SARS-CoV-2–associated sepsis and validated this definition against sepsis-3 criteria through medical record reviews, showing high sensitivity and specificity​​.
  7. Analysis and Trends: The incidence of SARS-CoV-2–associated sepsis varied with local case surges and new viral variants, with a notable decline in mortality over time. This decrease paralleled improvements in COVID-19 patient outcomes, likely due to better patient management and evolving virus strains​​.
  8. Implications and Recommendations: The study underscores the need for more nuanced sepsis diagnosis and treatment, moving away from the assumption that sepsis is predominantly bacterial. It calls for further research into diagnostic tests and biomarkers, especially for viral pathogens, to enable more targeted treatments and improve antibiotic stewardship​​.

In summary, this study provides valuable insights into the prevalence and outcomes of SARS-CoV-2–associated sepsis, emphasizing its significant but variable contribution to the overall sepsis burden during the COVID-19 pandemic. It also highlights the evolving nature of sepsis recognition and the importance of adapting diagnostic and treatment approaches to better address the role of viral pathogens.

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