Impact of the COVID-19 pandemic on the association between sepsis etiology and mortality among ICU patients in France.

OBJECTIVES

This study assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on in-hospital/90-day mortality factors, focusing on sepsis etiology among intensive care unit (ICU) sepsis patients.

METHODS

We analyzed 604,517 ICU sepsis patients (≥15 years) from French national database (2018-2022). Sepsis was identified using explicit and implicit ICD-10 infection codes. We compared prepandemic and pandemic mortality risk using separate multivariate logistic regression models for patients with and without co-infections, adjusted for demographics, comorbidities, and infection severity.

RESULTS

Overall in-hospital mortality was 29.2% and 90-day mortality was 34.0%. Prepandemic, viral sepsis had lower in-hospital mortality than bacterial sepsis, with co-infections (adjusted odds ratio [aOR] = 0.63 [99% confidence interval [CI] = 0.51-0.77]) and without (aOR = 0.67 [99% CI = 0.60-0.74]). During the pandemic, this reversed: viral sepsis (mainly COVID-19) showed higher mortality with co-infections (aOR = 1.41 [99% CI = 1.15-1.71]) and equivalent risk without (aOR = 1.01 [99% CI = 0.97-1.05]) compared with bacterial sepsis. Among patients without co-infections, mortality risk was higher for fungal/parasitic sepsis than for bacterial sepsis during the pandemic.

CONCLUSION

The pandemic modified sepsis-mortality associations, particularly for viral vs bacterial in-hospital mortality. These findings highlight the substantial mortality burden of COVID-19-related viral sepsis and underscore the need for specific viral sepsis ICD codes to accurately identify and manage this condition in future pandemics.