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The Link Between COVID-19 and Sepsis

COVID-19 and sepsis go hand in hand for COVID-19 patients who are hospitalized in the ICU. For the seriously ill, COVID-19 is much more than a respiratory infection. SARS-CoV-2, the virus that causes COVID-19, can impact multiple organs—not just the respiratory tract. This multi-organ dysfunction is essentially the definition of sepsis.

Sepsis is a body’s extreme, life-threatening immune response to an infection. This immune response results in multi-organ dysfunction that can escalate to tissue damage, organ failure, and even death.

“In COVID-19 sepsis, the infection is the virus, and the life-threatening organ dysfunction is all the organs that can dysfunction, including lungs, brain, kidneys, heart, and liver. These are all organs that are classically associated with sepsis. COVID-19 that causes organ dysfunction is viral sepsis,” said Steven Simpson, MD, professor of pulmonary and critical care medicine at The University of Kansas in Kansas City and medical adviser for the Sepsis Alliance, in an interview with HealthLeaders.1

COVID-19 Sepsis Symptoms and Impacts  

Illustration of COVID-19 Virus

The symptoms exhibited by COVID-19 sepsis patients overlap those experienced by septic shock patients overall and can include an altered mental state, difficulty breathing, reduced urine output, rapid heart rate, a weak pulse, and cold extremities.2

Sepsis from COVID-19 can impact any organs. However, the most commonly affected organs are the lungs, the cardiovascular system, the kidneys, the brain, the liver, and the coagulation system.3

These multi-organ impacts may result in long-lasting injury to organs. In fact, up to 50% of sepsis patients in general come away with long-term physical and/or psychological effects.4 A review of the current literature on post-acute COVID-19 found several lingering impacts for severely ill, hospitalized COVID-19 patients. For instance, dyspnea, or difficult and labored breathing, is common, with 42–66% prevalence at 60–100 days post hospital discharge.5 Similarly, chest pain was reported in up to 20% of acute COVID-19 survivors at 60 days follow-up.5

A Serious Medical Emergency

Sepsis can be deadly, regardless of the causative pathogen. In fact, sepsis is the leading cause of death in US hospitals.6 It is similarly deadly for patients suffering with acute COVID-19. “We know the mortality rate for COVID-19 patients in ICUs is in the range of 30%–40%,” said Steven Simpson, MD, in his interview with HealthLeaders.1

Treating sepsis often involves providing antibiotics or, when warranted, antifungals to treat the underlying infection. These therapies don’t work for viral sepsis. Antivirals have not been highly impactful in treating acute COVID-19, likely due to the patient’s dysregulated host response to the infection.3

“One of the problems with this illness is that it is not like a bacterial sepsis; where if you intervene with appropriate antibiotics early in the course of a bacterial sepsis, you can definitely keep it from progressing,” Simpson added. “We don’t have that capability with COVID-19.”1

Gray hospital building icon

COVID-19, Sepsis, and AMR

Despite antibiotics being ineffective for sepsis caused by COVID-19, a 2021 study found that during the worldwide pandemic, more than 70% of hospitalized COVID-19 patients received antibiotic therapy.7

 

That staggering number is likely due to the fact that clinicians didn’t want to wait for diagnostic results before starting patients on antibiotics that could be lifesaving—if started soon enough—in the case of bacterial sepsis. Traditional testing methods are slow and labor intensive, with results taking hours to days.

 

The problem with this approach is that unnecessary antibiotics can contribute to the escalating problem of antimicrobial resistance (AMR). One solution is timely diagnostics for fast identification of the probable causative pathogen, enabling clinicians to quickly discontinue broad-spectrum antibiotics when they are not necessary.

The Syndromic Approach

Several BIOFIRE syndromic testing solutions can be helpful in the case of suspected COVID-19 sepsis. The BIOFIRE® Respiratory 2.1 (RP2.1) Panel identifies SARS-CoV-2 and 21 other common respiratory pathogens, with results in about 45 minutes. Knowing if the patient has COVID-19 or not can help clinicians target therapy appropriately.

Co-infections can occur, with one study finding 20% of samples that tested positive for SARS-CoV-2 were also positive for at least one additional pathogen.8 With its comprehensive menu, the BIOFIRE RP2.1 Panel may help identify respiratory co-infections in one rapid test.

In cases where a secondary pneumonia infection is suspected, the BIOFIRE® FILMARRAY® Pneumonia Panel identifies 33 targets in about an hour, including 15 typical bacteria, 3 atypical bacteria, 8 viruses, and 7 antibiotic resistance genes. Semi-quantitative information is provided for the 15 typical bacteria, which may provide additional guidance in patient management.

The BIOFIRE® Blood Culture Identification 2 (BCID2) Panel can help pinpoint other possible causes of bloodstream infections that may lead to sepsis. The BIOFIRE BCID2 Panel tests for 43 clinically relevant targets, including gram-negative bacteria, gram-positive bacteria, yeast, and 10 antimicrobial resistance genes—all with one test and with results available in about an hour from positive blood culture. As with the BIOFIRE PN Panel, identification of antimicrobial resistance genes supports antimicrobial stewardship efforts and enables optimal treatment decisions.

Syndromic testing with BIOFIRE multiplex PCR panels provides fast, actionable answers. Even if the result is a viral pathogen like COVID-19, that knowledge can help clinicians reduce unnecessary antibiotics. And if there is a bacterial co-infection, prompt treatment can be lifesaving.

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REFERENCES:

  1. Cheney C. Severe Covid-19 Illness Is Viral Sepsis. HealthLeaders. 25 Nov 2020. Accessed on 29 July 2021. Retrieved from: https://www.healthleadersmedia.com/clinical-care/expert-severe-covid-19-illness-viral-sepsis 
  2. Beltrán-García J, et al. Crit Care Med. 2020;48(12):1841-1844.
  3. Vincent JL. Future Medicine.2021;16(3):131-133.
  4. Sepsis Alliance. Sepsis Fact Sheet. Retrieved from: https://www.sepsis.org/education/resources/sepsis-information-guides/
  5. Nalbandian A., et al. Nat Med 2021;27, 601–615.
  6. Lui V, et al. JAMA.2014;312(1):90-92.
  7. Rose A, et al. Open Forum Infect Dis. 2021;8(6).
  8. Kim D, et al. JAMA.2020;323(20):2085-2086

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