Sepsis of Patients Infected by SARS-CoV-2: Real-World Experience from the International HOPE-COVID-19-Registry and Validation of HOPE Sepsis Score

Abstract

Background: Sepsis patients with a concomitant Coronavirus (COVID-19) infection are related to a high morbidity and mortality rate. We investigated a large cohort of sepsis patients with a concomitant COVID-19 to determine clinical characteristics, laboratory and radiological findings, and predictors of mortality. We developed a risk score for the estimation of sepsis risk in patients with COVID-19.Methods: In the present study, we conducted a sub-analysis from the international Health Outcome Predictive Evaluation Registry for COVID-19 (HOPE-COVID-19-Registry). Out of 5,837 patients with COVID-19, 624 patients were diagnosed with sepsis according to the Sepsis-3 International Consensus.Findings: In multivariable analysis, the following risk factors were identified as independent predictors for developing sepsis: current smoking, tachypnoea (>22 breath per minute), haemoptysis, peripheral oxygen saturation (SpO2) 1.5 mg/dl. By assigning odds ratio weighted points to these variables, the following three risk categories were defined to develop sepsis during admission: low-risk group (probability of sepsis 3.1-11.8%); intermediate-risk group (24.8-53.8%); high-risk-group (58.3-100%). A score of 1 was assigned to current smoking, tachypnoea, decreased SpO2, decreased blood pressure, decreased GCS, elevated PCT, TnI, and creatinine, whereas a score of 2 was assigned to haemoptysis.Interpretation: The HOPE Sepsis Score including 9 parameters is useful in identifying high-risk COVID-19 patients to develop sepsis. Sepsis in COVID-19 is associated with a high mortality rate.Funding Statement: Non-conditioned grant (FUNDACIÓN INTERHOSPITALARIA PARA LA INVESTIGACIÓN CARDIOVASCULAR, FIC. Madrid, Spain)Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The study was approved by the Ethics Committee in all involved centres.