Coronavirus and Sepsis Outcome

SUMMARY

COVID-19 focused approach

For Healthcare Administrators: The largest age groups of developing COVID-19 and those admitted to the hospital are the 20-44 and 65-84 age ranges.

For Providers: Sepsis and mortality is greatest in the subset of patients meeting COVID-19 Critical disease definition

On March 27, 2020, the United States became the country with the greatest number of total coronavirus (COVID-19) cases in the world with almost 86,000 cases. We have learned a lot in the past few weeks about this virus.

This update is to add further clarity to COVID-19 as it relates to sepsis.

OVERVIEW

COVID-19 can present as mild, severe or critical disease:


Median time to ICU admission from onset of symptoms is 9.5 to 10.5 days.

Distribution of U.S. cases analyzed by the CDC show

  • Case distribution ranged from less than 20 to over 85 years of age
  • The distribution of COVID-19 by age was most common in the 20-44 group, followed by the 65-84 age group.
  • These 2 groups also had the largest percentages of patients hospitalized.

Patients 65 years of age or older accounted for 80% of deaths.

SEPSIS

A recent summary provided key findings from 72,314 cases by the Chinese Center for Disease Control and Infection

  • 44,672 confirmed cases
  • 16,186 suspected cases
  • 10,567 diagnosed cases
  • 889 asymptomatic cases

The disease breakdown was:

No deaths occurred in patients with mild or severe disease.

Critical disease patients meet the typical criteria for sepsis of dysregulated immune response with at least 1 organ failure due to documented or suspected infection. Although not provided, these patients should meet a SOFA score of 2 or higher.

  • 5% of patients manifested critical disease, indicating the need for ICU care.
  • Overall mortality was 2.3%.
  • 49% of patients with critical disease died

Patients between 70-79 years of age had an 8% mortality rate. Patients over age 80 had a 14.8 % mortality rate..

Analysis of all fatality revealed mortality was elevated in patients with preexisting comorbidities:

  • Cardiovascular disease 10.5%
  • Diabetes 7.3%
  • Chronic respiratory disease 6.3%
  • Hypertension 6.0%
  • Cancer 5.6%

TREATMENT

  • There are no proven or approved treatments for COVID-19. Current treatment is supportive care for ARDS, hypotension and sepsis.
  • The Surviving Sepsis Campaign will be publishing COVID-19 recommendations which re-iterate the previously published recommendations.
  • They will not recommend protease inhibitors class of antivirals due to the lack of data in the treatment of COVID-19.
  • The World Health Organization has launched a multi-country clinical trial evaluating the effect of 4 drug regimens already approved for other illnesses. Ten countries have agreed to participate.

Drug Regimens are:

  • Remdesivir
  • Lopinavir and ritonavir
  • Lopinavir, ritonavir with interferon beta
  • Chloroquine

CONCLUSIONS

  • Hand washing, social distancing, and self isolation remain the mainstays of our current response.
  • Patients within the COVID-19 critical disease category are the subset with mortality. Therefore, providers attempting to improve mortality outcome should focus on patients with critical disease COVID-19.
  • Aggressive supportive management to maintain hemodynamic and respiratory function (rehydration, low tidal volume, plateau pressure, PEEP)

Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.