The Clinical Features and Prognostic Assessment of SARS-CoV-2 Infection-Induced Sepsis Among COVID-19 Patients in Shenzhen, China.

Chao Ren,Ren-Qi Yao,Mian Peng,Yong Liu,Xue-Yan Liu,Ying Li,Yong-Wen Feng,Yao Yao,Lei Huang,Yong-Ming Yao,Di Ren,Jin-Xiu Li

doi:10.3389/fmed.2020.570853

Abstract

Background: The outbreak of the novel coronavirus disease (COVID-19) that began in December 2019 has posed a great threat to human health and caused a significant loss of life. In Shenzhen, 465 patients were confirmed to have COVID-19 as of August 31, 2020. In the present study, we aimed to describe the clinical characteristics of COVID-19 patients in Shenzhen and identify risk factors for the development of viral sepsis.Methods: In this retrospective study, patients who were confirmed to have a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and were admitted to the Third People's Hospital of Shenzhen from January 11 to April 27, 2020 were included in the cohort. Clinical data were extracted and followed up to May 10, 2020, by using predesigned data collection forms.Results: A total of 422 hospitalized COVID-19 patients were enrolled in this study, including 97 (23%) patients with viral sepsis at hospital admission and 325 (77%) non-septic patients. Patients with sepsis were much older than those without sepsis (57 vs. 43 years, P < 0.001) and presented with more comorbidities. Septic patients showed multiple organ dysfunction and significant abnormalities in immune- and inflammation-related biomarkers, and had poorer outcomes when compared to those without sepsis. Increased levels of interleukin-6, blood urea nitrogen, and creatine kinase were associated with the development of SARS-CoV-2-induced sepsis, and an elevated production of interleukin-6 was found to be an independent risk factor for the progression to critical illness among septic COVID-19 patients.Conclusions: SARS-CoV-2 infection-induced sepsis is critically involved in the severity and prognosis of COVID-19 patients by characterizing both aberrant immune response and uncontrolled inflammation. The development of sepsis might contribute to multiple organ dysfunction and poor outcomes in COVID-19 patients during hospitalization.

Highlights

The novel coronavirus disease (COVID-19) that was firstly reported in Wuhan, Hubei province, China, has caused significant loss of life [1, 2]
We solely considered sepsis caused by the severe acute respiratory syndrome (SARS)-CoV-2 infection, and patients with positive culture results at hospital admission were excluded from the sepsis cohort
By using least absolute shrinkage and selection operator (LASSO) regression analysis, we further identified risk factors for the development of sepsis (Figure 5, Supplementary Figure S1) and found that changes in platelet counts, C-reactive proteins (CRP), IL-6, blood urea nitrogen (BUN), and creatine kinase (CK) levels might be useful for predicting the incidence of viral sepsis among COVID-19 cases

Summary

Introduction

The novel coronavirus disease (COVID-19) that was firstly reported in Wuhan, Hubei province, China, has caused significant loss of life [1, 2]. From the first occurrence of COVID-19 on January 11, 2020, to August 31, 2020, 465 patients were confirmed with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection in Shenzhen, China, including one patient who remained in the hospital, three patients who died, and 462 patients who were discharged [5]. The outbreak of the novel coronavirus disease (COVID-19) that began in December 2019 has posed a great threat to human health and caused a significant loss of life. We aimed to describe the clinical characteristics of COVID-19 patients in Shenzhen and identify risk factors for the development of viral sepsis

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Conclusion