Coronavirus and Sepsis

Sepsis

Global Sepsis Alliance, Can COVID-19 cause sepsis

COVID-19 does indeed cause sepsis

Sepsis is “a life-threatening organ dysfunction caused by a dysregulated host response to infection.”

Other organs as well as the lungs

Direct viral invasion and sepsis

Seattle area in the United States, ICU patients

Septic shock severe enough to require drugs to support the heart and circulation in almost, 70%

Liver injury, over 30% had evidence of liver injury

Depressed immune response, 75%

Acute kidney failure, 20%

Chinese data

Significant heart damage, 28%

Potentially from direct invasion of cardiac muscle by the virus

Resulting in heart failure and abnormal heart rhythms

This cardiac damage was associated with a five-fold increase in the risk of death

COVID-19 causing sepsis

Critical Care Explorations (June, 2020)

Research technique

Multisystemic clinical and autopsy findings

Viral sepsis accurately describes the whole clinical picture

Pathophysiology

Intense cytokine release

Prolonged inflammation

Immunosuppression with T cell exhaustion

Lymphopenia and immunosuppression

Organ dysfunctions

Management

Optimal treatment uncertain

Supportive treatment and immunomodulators

Until effective antivirals are developed

UK Sepsis Trust

A life-threatening condition

When the body’s response to infection injures its own tissues and organs

A percentage of COVID-19 infections can result in such organ damage and subsequent failure

Therefore features in addition to respiratory failure

Acute

Chronic

Sepsis associated with infection, any of the following

Slurred speech or confusion

Extreme shivering or muscle pain

Passing no urine (in a day)

Severe breathlessness

It feels like you’re going to die

Skin mottled or discoloured

Clinical observations

Temperature

above 38.5 (101.3)

below 35 (95)

Heart rate above 90 / minute

Breathing more than 20 / minute

Blood sugar, above 6.6 mmo/L (118 mg/dL)

White cells high or low

CRT more than 3 seconds

AMS

Note

Breathlessness, cough and fever are common in COVID-19

Sepsis SOB

Severe breathlessness

Very short of breath at rest

Breathing very rapidly, 30 minute or more

Cannot say more than 2-3 words at a time

Cyanosis, central or peripheral

Global, regional, and national sepsis incidence and mortality,

1990–2017: analysis for the Global Burden of Disease Study (Lancet, 16 January 2020)

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In 2017

48·9 million cases of sepsis were

11 million deaths (19.7% of global deaths)

56 million people died in 2017

1990 – 2017

37·0% reduction in incidence of sepsis

52·8% reduction in mortality

Highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia.

Post-sepsis syndrome – an evolving entity that afflicts survivors of sepsis

Sequelae of sepsis

Were thought to be independent of sepsis itself

Either comorbidities or complications of critical illness

Recent studies, consistent patterns in sepsis survivors

Lasting months to years after symptoms of active sepsis resolved

Post-sepsis syndrome

Significantly increased risk of death

Poor health-related quality of life

After 2 years

50% recovery

33% died

17% post sepsis syndrome

Often the recovery is not complete

Constellation of long-term effects

Neurocognitive impairment

Functional disability

Anxiety, depression, PTSD

Psychological deficits

Metabolic effects

Organ dysfunction

Gut dysbiosis

Stroke

Myocardial infarction

Fatal coronary artery disease

Redevelopment of sepsis

Exacerbation of previous chronic illness.

Rehospitalization rate

Post sepsis infection most common reason (12%)

Mostly pneumonia

30 days, 20 - 32%

90-day, 40%

One-year, 63%