Coronavirus Disease 2019 as Cause of Viral Sepsis: A Systematic Review and Meta-Analysis*

Abstract

Objective: Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ dysfunction syndrome in its severe forms. The prevalence of coronavirus disease 2019–related sepsis is still unclear; we aimed to describe this in a systematic review. Data Sources: MEDLINE (PubMed), Cochrane, and Google Scholar databases were searched based on a prespecified protocol (International Prospective Register for Systematic Reviews: CRD42020202018). Study Selection: Studies reporting on patients with confirmed coronavirus disease 2019 diagnosed with sepsis according to sepsis-3 or according to the presence of infection-related organ dysfunctions necessitating organ support/replacement were included in the analysis. The primary end point was prevalence of coronavirus disease 2019–related sepsis among adults hospitalized in the ICU and the general ward. Among secondary end points were the need for ICU admission among patients initially hospitalized in the general ward and the prevalence of new onset of organ dysfunction in the ICU. Outcomes were expressed as proportions with respective 95% CI. Data Extraction: Two reviewers independently screened and reviewed existing literature and assessed study quality with the Newcastle-Ottawa Scale and the Methodological index for nonrandomized studies. Data Synthesis: Of 3,825 articles, 151 were analyzed, only five of which directly reported sepsis prevalence. Noting the high heterogeneity observed, coronavirus disease 2019–related sepsis prevalence was 77.9% (95% CI, 75.9–79.8; I 2 = 91%; 57 studies) in the ICU, and 33.3% (95% CI, 30.3–36.4; I 2 = 99%; 86 studies) in the general ward. ICU admission was required for 17.7% (95% CI, 12.9–23.6; I 2 = 100%) of ward patients. Acute respiratory distress syndrome was the most common organ dysfunction in the ICU (87.5%; 95% CI, 83.3–90.7; I 2 = 98%). CONCLUSIONS: The majority of coronavirus disease 2019 patients hospitalized in the ICU meet Sepsis-3 criteria and present infection-associated organ dysfunction. The medical and scientific community should be aware and systematically report viral sepsis for prognostic and treatment implications.

Analysis of Deaths and Favorable Developments of Patients with SARS-CoV-2 Hospitalized in the Largest Hospital for Infectious Diseases and Pneumo-Phthisiology in the West of the Country

“…In fact, the prevalence of sepsis among COVID-19 cases was estimated at 39.9% (95% CI, 35.9–44.1) in a first meta-analysis published in December 2020. 55 …”

Identification of Coinfections by Viral and Bacterial Pathogens in COVID-19 Hospitalized Patients in Peru: Molecular Diagnosis and Clinical Characteristics

“…We observed a higher proportion of sepsis in those patients with coinfections compared to monoinfection. SARS-CoV-2 has been reported to induce viral sepsis associated with secondary organ dysfunction in 25% and 83% of COVID-19 patients hospitalized in general services and critical care units, respectively [ 39 , 40 ]. Possible mechanisms proposed are increase in bacterial adherence, cellular destruction by viral enzymes, reduction of mucociliary clearance, reduction in chemotaxis, reduction in surfactant levels, dysbiosis of the microbiome, dysregulation of immune response and bacterial–viral synergism, among others [ 41 ].…”

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

“…Patients presenting with COVID-19 pneumonia share common features with bacterial pneumonia (fever, cough, dyspnea, infiltrates in chest X-ray, and elevated inflammation markers) making the differential diagnosis troublesome. In severe cases, COVID-19 may resemble bacterial sepsis leading to multiorgan failure and requiring organ support in the ICU [85]. Although data are very heterogenous, unlike other viral respiratory diseases, bacterial co-infection at the time of hospital admission is rare in COVID-19; this may occur during hospital and/or ICU stay.…”