Comparative Evaluation of the Prognosis of Septic Shock Patients from Before to After the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis

Abstract

In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the ED of a tertiary medical center in South Korea from February 2019 to February 2021. Following the COVID-19 pandemic onset, revised institutional ED processes included a stringent isolation protocol for patients visiting the ED. The primary goal of this study was to determine the mortality rate of septic shock patients from before and after the onset of the COVID-19 pandemic. Durations of vasopressor use, mechanical ventilation, intensive care unit stay, and hospitalization were investigated. The mortality rates increased from 24.8% to 35.8%, before and after COVID-19-onset, but the difference was not statistically significant (p = 0.079). No significant differences in other outcomes were found. Multivariable analysis revealed that the Simplified Acute Physiology Score III (SAPS III) was the only risk factor for mortality (OR 1.07; 95% CI 1.04-1.10), whereas COVID-19 pandemic was not included in the final model. The non-significant influence of the COVID-19 pandemic on septic shock mortality rates in the present study belies the actual mortality-influencing potential of the COVID-19 pandemic.

Epidemiology and Outcome of Acute Appendicitis during and before the COVID-19 Pandemic: A Retrospective Single-Center Analysis

“…In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan, China and soon became a pandemic. During the early stages of the pandemic, the majority of medical resources were focused on the care of patients with COVID-19, and the pandemic impacted the systems of emergency medical centers and affected the diagnosis and treatment processes of patients without COVID-19 [ 1 , 2 , 3 ]. Furthermore, a gap in emergency medical services developed for other diseases, including myocardial infarction, stroke, out-of-hospital cardiac arrest (OHCA), and sepsis, owing to the collateral effects [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ].…”

“…During the early stages of the pandemic, the majority of medical resources were focused on the care of patients with COVID-19, and the pandemic impacted the systems of emergency medical centers and affected the diagnosis and treatment processes of patients without COVID-19 [ 1 , 2 , 3 ]. Furthermore, a gap in emergency medical services developed for other diseases, including myocardial infarction, stroke, out-of-hospital cardiac arrest (OHCA), and sepsis, owing to the collateral effects [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Previous studies have revealed that patients with these life-threatening diseases experienced delays in arrival through overburdened emergency medical services and medical institutions with limited capacity, restricting their access to proper care [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ].…”

“…Furthermore, a gap in emergency medical services developed for other diseases, including myocardial infarction, stroke, out-of-hospital cardiac arrest (OHCA), and sepsis, owing to the collateral effects [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Previous studies have revealed that patients with these life-threatening diseases experienced delays in arrival through overburdened emergency medical services and medical institutions with limited capacity, restricting their access to proper care [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Additionally, the pandemic’s impact on emergency rooms altered the care provided to patients requiring surgical treatment.…”

“…Access to EDs was restricted compared to before the pandemic, and patients had a generalized fear of infection risk from the novel virus [ 14 , 15 ]. Moreover, additional procedures during diagnostic testing and subsequent surgery, including the need for personal protection of the clinician and care in an isolation area when the patient presents symptoms and signs of a febrile illness, and the proactive administration of a COVID-19 polymerase chain reaction (PCR) test preoperatively, may lengthen the time until the surgery [ 2 ].…”

The impact of COVID-19 pandemic on revisits to emergency department

“…The clinical process in the emergency department also changed. For example, patients with suspected COVID-19 infection had to use isolation rooms, and physicians had to wear personal protective equipment to prevent the spread of COVID-19 infection in South Korea [7] , [8] . These changes might also have impacted the ED revisit.…”