Managing specific infectious diseases: A to Z
Study Finds SARS-CoV-2-associated Sepsis Was More Common, Deadly Than Previously Thought
New research suggests that the virus responsible for COVID-19 was a more common and deadly cause of sepsis during the initial period of the pandemic than previously assumed.
The study, led by investigators from Brigham and Women's Hospital, a founding member of the Mass General Brigham health care system, used electronic health record (EHR) data from five Mass General Brigham hospitals to track the rate of SARS-CoV-2-associated sepsis during the COVID-19 pandemic. The team found that SARS-CoV-2 accounted for approximately one in six cases of sepsis during the first two and a half years of the COVID-19 pandemic.
Their results, published in JAMA Network Open, suggest clinicians should rethink how they treat sepsis while also providing a framework for future surveillance for viral sepsis.
"Most people, including medical professionals, equate sepsis with bacterial infections," said lead author Claire Shappell, MD, MPH, of the Division of Pulmonary and Critical Care Medicine in the Department of Medicine at Brigham and Women's Hospital.
"This is reflected in treatment guidelines and quality measures that require immediate antibiotics for patients with suspected sepsis. However, viral infections, including the SARS-CoV-2 virus that causes COVID-19, can trigger the same dysregulated immune response that leads to organ dysfunction as in bacterial sepsis."
Previous research on viral sepsis has been limited. To capture a full and more accurate picture of sepsis cases, the team utilized electronic health records from Mass General Brigham hospitals during the study period.
"Previous efforts to quantify the burden of SARS-CoV-2-associated sepsis have been limited by inconsistent definitions and under-recognition of viral sepsis," said senior author Chanu Rhee, of the Division of Infectious Diseases in the Department of Medicine at Brigham and Women's Hospital.
"Our prior research has shown that EHR-based surveillance can provide more accurate estimates of sepsis incidence and outcomes compared to administrative datasets, but this method had not previously been applied specifically for sepsis associated with SARS-CoV-2 or other viruses."
The team quantified the incidence and mortality for SARS-CoV-2-associated sepsis using clinical criteria adapted from the Center for Disease Control and Prevention's (CDC) sepsis surveillance definition that incorporated positive SARS-CoV-2 tests and clinical signs of organ dysfunction.
Using EHR data between March 2020 and November 2022, the team identified 431,017 hospitalizations from 261,595 individuals. During that time, 5.4% of hospitalizations were due to SARS-CoV-2 infections and 28.2% of those hospitalizations had SARS-CoV-2-associated sepsis.
The mortality rate for patients with SARS-CoV-2-associated sepsis was initially high—33% over the first three months of the pandemic. However, it declined over time and eventually became similar to the mortality rate for presumed bacterial sepsis, a rate of about 14.5% that remained stable throughout the study period. The researchers also confirmed their electronic surveillance definition accurately identified cases of viral sepsis caused by SARS-CoV-2 infections using the Mass General Brigham EHR dataset.
The study's design and utilization of EHR data provides a framework for future research into sepsis associated with other viruses, including influenza and respiratory syncytial virus (RSV). The team hopes to apply this method to larger and nationally representative datasets to report generalizable epidemiologic data on viral sepsis.
"Our study draws attention to the high burden and poor outcomes associated with viral sepsis, while demonstrating the utility of using EHR-based algorithms to conduct surveillance for both viral and bacterial sepsis," said Shappell. "We also hope our findings highlight that sepsis is not a 'one-size-fits-all' entity, but one that requires clinicians to tailor their diagnosis and treatment strategy to each patient's syndrome and probable pathogen."
More information: Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2-Associated Sepsis, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.35728
Citation: Study finds SARS-CoV-2-associated sepsis was more common, deadly than previously thought (2023, September 29) retrieved 27 October 2023 from https://medicalxpress.Com/news/2023-09-sars-cov-associated-sepsis-common-deadly-previously.Html
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New Rapid Blood Tests Can Spot Deadly Sepsis And Also Flag Up Signs Of Ten Other Serious Diseases In Minutes
Severely ill patients could soon be given a blood test that can show in seconds if they have sepsis – the immune system reaction that can kill within hours.
The £100 single-use kit – which works using the same technology as Covid rapid lateral flow tests – could also be used to spot the early signs of other diseases, including cancer and heart disease.
Sepsis occurs when bacterial infections such as pneumonia, or viral infections, including flu, send the immune system haywire, causing it to attack major organs. About 150,000 people a year are admitted to hospital with the condition, and it leads to about 48,000 deaths, but there is no reliable test for it.
The British scientists behind the kit, known as a multiplex test, which could be given to paramedics and hospital teams, say it could be available in the UK by 2025 and save thousands of lives each year.
'Right now, it takes far too long to diagnose sepsis,' says Dr Mike Hudson, chief executive of EDX Medical, the firm behind the test. 'Our blood test could help get people into hospital quicker and reduce the number of sepsis deaths.'
In March, actor Jason Watkins (pictured) said the death of his two-year-old daughter Maude due to sepsis in 2011 was avoidable because hospital staff missed the warning signs
Sepsis occurs when bacterial infections such as pneumonia , or viral infections, including flu , send the immune system haywire, causing it to attack major organs
'Right now, it takes far too long to diagnose sepsis,' says Dr Mike Hudson, chief executive of EDX Medical, the firm behind the test. 'Our blood test could help get people into hospital quicker and reduce the number of sepsis deaths'
There are at least 245,000 cases of sepsis in the UK every year, many developing while patients are in hospital. The first symptoms are often severe breathlessness, high temperature, slurred speech or disorientation. However, these are often missed by doctors or mistaken for less severe conditions.
In March, actor Jason Watkins said the death of his two-year-old daughter Maude due to sepsis in 2011 was avoidable because hospital staff missed the warning signs.
Experts say they have long known what changes in the blood – known as biomarkers – are linked to sepsis, but have not been able to build a rapid test that can reliably diagnose the condition.
'There are biomarkers in the blood you can look out for that suggest something is going wrong in the immune system,' says Dr Hudson, 'but there are around three to five different biomarkers that all need to be there to prove it's sepsis, otherwise it could just be a fever.
'Currently we can carry out a test in a lab that can spot these changes, which can take up to a day, but the rapid test technology that can be done in the patient's home, by a GP or ambulance crew isn't there yet.'
Dr Hudson believes the test will be the answer to that problem.
A finger-prick sample of blood is dropped on to the device, and within minutes dots on a paper screen flag up different biomarkers that are present in the blood.
'If you did the test and three out of five of the sepsis biomarkers flashed up, it would be clear the patient needed urgent specialist hospital treatment,' says Dr Hudson.
Trials have found that the test can spot most biomarkers linked to sepsis. Other biomarkers could indicate up to ten other diseases, including bladder, pancreatic, cervical and breast cancer, the makers say.
A study of the test's effectiveness is due to be published before the end of the year.
Eye On Health: Sepsis, 'You Can Be The Healthiest Person On The Planet And Still Develop Sepsis.'
LAFAYETTE, La. (KLFY) – Sepsis is a life-threatening complication of an infection and the leading cause of death in the U.S.
Only 35% of U.S. Adults have heard of it, let alone know what it is. Dr. Brianna Shaffer with Our Lady of Lourdes Hospital in Lafayette says, "You can be the healthiest person on the planet and still develop sepsis."
It's severe strike to the body can cause multi organ disfunction and failure. Dr. Shaffer says sepsis can be caused by a number of different things. Typically developing from a general infection. "The most common being viral illnesses, bacterial illnesses, parasites and fungi can cause patients to develop an infection," said Schaffer
Anyone can develop sepsis. However, small children, the elderly and patients with pre-existing disorders like diabetes, hypertension, underlying cardiovascular disease, and patients who are immunocompromised have a higher risk of developing sepsis.
Sepsis can also be detrimental to pregnant moms and their unborn baby. "Sepsis can affect a growing fetus depending on how far along the pregnancy is. The most serious being death for mother and/or the baby," says Dr. Schaffer.
When looking out for sepsis patients you should refer to the mnemonic T.I.M.E. Pay close attention to your temperature, infection, mental status and illness. Anyone can prevent sepsis by washing your hands with soap and water several times a day for 20 seconds. Avoid unnecessary contact with people who are sick or infected and staying up to date on your vaccines.
If you suspect you are sick or have a general infection, reach out to your doctor as soon as possible.
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