Study finds unacknowledged role of viral infections in sepsis

The end of Sepsis Awareness Month, as well as the publishing of the report, serve as a timely reminder of the importance of sepsis research.

The report was published in JAMA Network Open under the title "Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2-Associated Sepsis."

Sepsis refers to a severe infection that causes organ failure. It is a major cause of death, disability, and increased medical costs.

Although most medical professionals and academics associate sepsis with bacterial infections, the COVID-19 pandemic has demonstrated that viral infections can also play a key role in the development of sepsis. Few studies, however, have looked at how much of a burden viral infections bring to sepsis in general, as well as how those with viral sepsis perform in comparison to those with bacterial sepsis.

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, Harvard Medical School Associate Professor of Population Medicine at the Harvard Pilgrim Health Care Institute.

Our prior research has shown that electronic health record (EHR)-based surveillance using clinical markers of infection and organ dysfunction can provide more accurate estimates of sepsis incidence and outcomes compared to using hospital discharge diagnosis codes, but this method had not previously been applied specifically for sepsis associated with SARS-CoV-2 or other viruses.

The study researchers performed a retrospective cohort study using EHR data for all adults admitted to five Massachusetts hospitals between March 2020 and November 2022. The team quantified the incidence and in-hospital mortality for sepsis associated with SARS-CoV-2 infections using clinical criteria adapted from CDCs sepsis surveillance definition that incorporated positive SARS-CoV-2 tests and clinical signs of organ dysfunction. They found that approximately 1 in 6 cases of sepsis were associated with SARS-CoV-2 during this period.

The researchers also confirmed their electronic surveillance definition accurately identified cases of viral sepsis caused by SARS-CoV-2 infections using detailed medical record reviews.

Our study draws attention to the high burden and poor outcomes associated with viral sepsis, while also demonstrating the utility of using EHR-based algorithms to conduct surveillance for both viral and bacterial sepsis, said Claire Shappell, a former research fellow at the Harvard Pilgrim Health Care Institute and lead author of the study.

Dr. Shappell, now a Harvard Medical School Instructor of Medicine in the Division of Pulmonary and Critical Care Medicine at Brigham and Womens Hospital, adds, Current sepsis treatment protocols often presume sepsis is caused by bacteria and suggest treating all patients with sepsis with broad-spectrum antibiotics and intravenous fluids. We hope our findings will 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 patients syndrome and probable pathogen. (ANI)