We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2–Associated Sepsis.
- Authors
Shappell, Claire N.; Klompas, Michael; Chan, Christina; Chen, Tom; Kanjilal, Sanjat; McKenna, Caroline; Rhee, Chanu
- Abstract
Key Points: Question: How did the frequency and mortality for SARS-CoV-2–associated sepsis differ from presumed bacterial sepsis during the COVID-19 pandemic? Findings: In this retrospective cohort study of 431 017 inpatient encounters at 5 Massachusetts hospitals between March 2020 and November 2022, SARS-CoV-2–associated sepsis was present in 1.5% of all admissions and 28.2% of SARS-CoV-2–positive hospitalizations, whereas presumed bacterial sepsis was present in 7.1% of hospitalizations. Between the first and last study quarters, SARS-CoV-2–associated sepsis mortality decreased from 33.4% to 14.9% while presumed bacterial sepsis mortality was stable at 14.5%. Meaning: These findings suggest that SARS-CoV-2–associated sepsis was common and had higher mortality than presumed bacterial sepsis early in the COVID-19 pandemic. This cohort study assesses the incidence and outcomes of SARS-CoV-2–associated sepsis vs presumed bacterial sepsis by using objective electronic clinical criteria at 5 Massachusetts hospitals. Importance: Efforts to quantify the burden of SARS-CoV-2–associated sepsis have been limited by inconsistent definitions and underrecognition of viral sepsis. Objective: To describe the incidence and outcomes of SARS-CoV-2–associated sepsis vs presumed bacterial sepsis using objective electronic clinical criteria. Design, Setting, and Participants: This retrospective cohort study included adults hospitalized at 5 Massachusetts hospitals between March 2020 and November 2022. Exposures: SARS-CoV-2–associated sepsis was defined as a positive SARS-CoV-2 polymerase chain reaction test and concurrent organ dysfunction (ie, oxygen support above simple nasal cannula, vasopressors, elevated lactate level, rise in creatine or bilirubin level, and/or decline in platelets). Presumed bacterial sepsis was defined by modified US Centers for Disease Control and Prevention adult sepsis event criteria (ie, blood culture order, sustained treatment with antibiotics, and organ dysfunction using identical thresholds as for SARS-CoV-2–associated sepsis). Main Outcomes and Measures: Trends in the quarterly incidence (ie, proportion of hospitalizations) and in-hospital mortality for SARS-CoV-2–associated and presumed bacterial sepsis were assessed using negative binomial and logistic regression models. Results: This study included 431 017 hospital encounters from 261 595 individuals (mean [SD] age 57.9 [19.8] years, 241 131 (55.9%) females, 286 397 [66.5%] from academic hospital site). Of these encounters, 23 276 (5.4%) were from SARS-CoV-2, 6558 (1.5%) had SARS-CoV-2–associated sepsis, and 30 604 patients (7.1%) had presumed bacterial sepsis without SARS-CoV-2 infection. Crude in-hospital mortality for SARS-CoV-2–associated sepsis declined from 490 of 1469 (33.4%) in the first quarter to 67 of 450 (14.9%) in the last (adjusted odds ratio [aOR], 0.88 [95% CI, 0.85-0.90] per quarter). Crude mortality for presumed bacterial sepsis was 4451 of 30 604 patients (14.5%) and stable across quarters (aOR, 1.00 [95% CI, 0.99-1.01]). Medical record reviews of 200 SARS-CoV-2–positive hospitalizations confirmed electronic health record (EHR)–based SARS-CoV-2–associated sepsis criteria performed well relative to sepsis-3 criteria (90.6% [95% CI, 80.7%-96.5%] sensitivity; 91.2% [95% CI, 85.1%-95.4%] specificity). Conclusions and Relevance: In this retrospective cohort study of hospitalized adults, SARS-CoV-2 accounted for approximately 1 in 6 cases of sepsis during the first 33 months of the COVID-19 pandemic. In-hospital mortality rates for SARS-CoV-2–associated sepsis were high but declined over time and ultimately were similar to presumed bacterial sepsis. These findings highlight the high burden of SARS-CoV-2–associated sepsis and demonstrate the utility of EHR-based algorithms to conduct surveillance for viral and bacterial sepsis.
- Subjects
MASSACHUSETTS; BACTEREMIA; PUBLIC health surveillance; COVID-19; CONFIDENCE intervals; RETROSPECTIVE studies; SEPSIS; HOSPITAL mortality; DESCRIPTIVE statistics; RESEARCH funding; ELECTRONIC health records; LOGISTIC regression analysis; ODDS ratio; POLYMERASE chain reaction; LONGITUDINAL method; ALGORITHMS; EVALUATION
- Publication
JAMA Network Open, 2023, Vol 6, Issue 9, pe2335728
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.35728