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Impacts of COVID-19-Associated Sepsis on In-Hospital Mortality Rates: Detailed Study

During the challenging period of the COVID-19 pandemic, a high incidence of COVID-19-associated sepsis was noticed, leading to a significantly higher rate of in-hospital mortality compared to presumed bacterial sepsis. This discovery was illuminated through a study published in JAMA Network Open, in which researchers painstakingly conducted a retrospective cohort study among adults in five Massachusetts hospitals from March 2020 through November 2022. The purpose of this study was to draw a thoughtful comparison between the incidence and outcomes of COVID-19-associated sepsis and presumed bacterial sepsis.

A host of patient data was amassed for the study, capturing information from adults who were admitted as inpatients, under observation status, or even those who lost their lives in the emergency department. To evaluate trends in quarterly incidence of hospital admission and in-hospital mortality for both COVID-19-associated sepsis and presumed bacterial sepsis, negative binomial and logistic regression models were employed.

The diagnoses of COVID-19-associated sepsis were determined through the utilization of electronic health record (EHR)-based criteria. Researchers analyzed a total of 431,017 hospital encounters which represented 261,595 patients, among whom 1.5% of hospital encounters were for COVID-19-associated sepsis and 7.1% were for presumed bacterial sepsis.

In relation to crude in-hospital mortality, a noticeable decrease was observed over time for COVID-19-associated sepsis but, strikingly, no such change was observed for presumed bacterial sepsis. Other revelatory pieces of information include risk predictors like age, BMI, and high Elixhauser index scores. However, by the study end, there was no significant difference in in-hospital mortality rates between patients with COVID-19-associated sepsis and those with presumed bacterial sepsis.

The study, while rich in details, is not without its limitations like potential ascertainment bias, the use of EHR-based criteria to determine COVID-19-associated sepsis, and being restricted to a single-center setting. Plus, findings may not precisely reflect pandemic trends due to substantial variation in the quarterly incidence of in-hospital mortality for COVID-19-associated sepsis.

The research group, while acknowledging these constraints, points out the utility of EHR-based algorithms to conduct surveillance for viral and bacterial sepsis. The results highlight the high burden of SARS-CoV-2-associated sepsis, which requires attention from those concerned in the healthcare sector. Note: Few study authors are affiliated with biotech, pharmaceutical, and device companies. For a complete list of disclosures, please refer to the original reference.


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