Sepsis Caused by Coronavirus Disease 2019: A Two-Center Retrospective Study

Abstract

Objective: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout the world. The mortality rate of patients with COVID-19 significantly increased after progression to sepsis. However, the risk factors for sepsis in patients with COVID-19 have not been reported.

Methods: We extracted data regarding 154 patients with laboratory-confirmed COVID-19 from 2 hospitals in China through March 20, 2020. All cases were divided into sepsis and nonsepsis groups based on the Sepsis-3.0 definition. Demographic, clinical, laboratory and outcome data were extracted from electronic medical records. In addition, we used multivariable logistic regression methods to explore the risk factors associated with sepsis.

Results: A total of 79 (51.3%) patients were men, with a mean age of 49.6 years. Of these patients, 28 (18.2%) were in the sepsis group, and 126 (81.8%) were in the nonsepsis group. In the sepsis group, the proportions of basic diseases, including hypertension, diabetes, and malignant tumors, as well as the quick Sequential Organ Failure Assessment (qSOFA) score, were significantly higher than those in the nonsepsis group (all p <0.05). The incidence of acute respiratory distress syndrome (ARDS), septic shock, acute heart loss, liver dysfunction, and gastrointestinal bleeding was significantly higher in the sepsis group than in the nonsepsis group (all p<0.05). The overall hospital mortality was 3.3% and was significantly higher in sepsis patients (17.9%) than in nonsepsis patients (0%, p<0.01). Multivariable regression showed that a high level of activated partial thromboplastin time (APTT) (1.251, 1.021-1.533; p=0.031) and a high qSOFA score (55.066, 7.526-402.926; p<0.001) were independent risk factors for sepsis in patients with COVID-19; however, higher hemoglobin was associated with lower odds of sepsis in patients with COVID-19 (0.946, 0.902-0.993; p= 0.024).

Conclusion: COVID-19 patients have more severe illness and worse prognosis after progression to sepsis. The potential risk factors of a high qSOFA score and APTT level or a low level of hemoglobin level could help clinicians identify COVID-19 patients with sepsis at an early stage.

Trial Registration: The study was registered in the Chinese Clinical Trial Registry (Registration Number: ChiCTR-OOC-17013223)

Funding Statement: Contract grant sponsor: Social Development Funds of Jiangsu Province; Contract grant number: BE2017691; National Natural Science Foundations of China; Contract grant number: 81670065; Social Development Funds of Yangzhou City; Contract grant number: YZ2018075.

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: The study was approved by the Research Ethics Commission of The First People's Hospital of Jiangxia District (KY-2020–05) and Western District Hospital of Northern Jiangsu People's Hospital (2020KY-157), and the requirement for informed consent was waived by the Research Ethics Commission.