Could SARS-CoV-2 Sepsis Be a Different Phenotype of Sepsis? COVID-19 Pneumosepsis with Its Similarities and Differences

Abstract

Objective: By comparing viral sepsis caused by SARS CoV-2 with pneumosepsis caused by other pathogens, we aimed to compare the pathogen– host relationship, organ damage affecting the clinic, and similar and different features of the two types of sepsis. Materials and Methods: A total of 414 patients diagnosed with critical COVID-19 between 2019 and 2021 and 303 pneumosepsis cases that met the diagnostic criteria for sepsis-3 between 2016 and 2019 admitted to the Anesthesiology and Reanimation Intensive Care Unit (ICU) were retrospectively screened. The patient’s demographic data, mortality rates, length of stay in the intensive care unit, development of secondary organ dysfunction, presentation values of laboratory and mechanical ventilation, and changes within the 1-week follow-up were compared. Results: The SOFA scores were significantly higher in the COVID-19 sepsis group at presentation (8.2±2.9 vs.7.2±3.7; p<0.0001) and during follow-up (8.9 ± 4.9 vs. 7.8 ± 3.7; p=0.002). The mean age of the patients was 65.4 ± 17.2 years in the non-COVID-19 sepsis group and 57.9 ± 17.1 years in the COVID-19 sepsis group (p<0.0001). The number of days on mechanical ventilation was significantly higher in the COVID-19 sepsis group (p=0.018). Mortality was detected in 299 patients (41.7%) in total, with no significant difference being observed between the two groups (p=0.592). Conclusion: Despite the patient population having a lower mean age and fewer comorbidities, organ dysfunction was higher in COVID-19 sepsis patients during admission to the ICU and follow-up. While the pathogen causing sepsis can be brought under control with rapid diagnosis and appropriate antimicrobial treatment, organ damage cannot be controlled with appropriate antiviral treatment in COVID-19 sepsis. In COVID-19 sepsis, secondary organ damage may be more evident as a result of damage and immunomicrothrombosis, which causes high mortality and morbidity, the mechanism of which has not yet been fully elucidated.

Keywords

• covid-19 sepsis
• sofa score
• pneumosepsis
• organ damage