Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Edgar M. Landa, N/A – Texas Tech University Health Sciences Center Co-Author: John Garza, PhD – Doctor, Texas Tech University Health Sciences Center at the Permian Basin Co-Author: Hamza Khair, MD – Texas Tech University Health Sciences Center at the Permian Basin Co-Author: Anu Twayana, N/A Co-Author: Abira Usman, N/A Co-Author: Lavi Oud, MD – Dr., Texas Tech University Health Sciences Center
Introduction: COVID-19 was associated with high mortality in sepsis and septic shock during the early pandemic period. However, mortality in COVID-19-associated sepsis was reported to decrease over time, becoming similar to that of non-COVID sepsis on indirect comparisons. We examined the population-level trends in the association of COVID-19 with short-term mortality in septic shock.
Methods: We used statewide data to identify hospitalizations aged 18 years or older with septic shock in Texas between 04/1/2020 and 12/31/2023. Septic shock and COVID-19 were defined using ICD-10 codes R6521 and U071, respectively. Hierarchical logistic models were used to estimate the association of time (quarters) with short-term mortality (in-hospital death or discharge to hospice) among septic shock hospitalizations. Interaction terms were included between COVID-19 status (with non-COVID as reference) and time overall and on sensitivity analyses among those aged ≥65 years and the mechanically ventilated.
Results: Among 246,026 hospitalizations with septic shock, 17.5% had COVID-19. Compared to those without COVID-19, those with COVID-19 were younger (aged ≥65 years 53.7% vs 57.7%), but more commonly mechanically ventilated (50.1% vs 26.5%) (p < 0.0001 for both comparisons). Short-term mortality among septic shock hospitalizations with and without COVID-19 was 67.0% vs 41.1% overall and 45.1% vs 39.4% during the last quarter of 2023, respectively. On adjusted analyses, COVID-19 was associated with increased short-term mortality (adjusted odds ratio [aOR] 4.26 [95% CI 3.84-4.32]). There were significant interactions between COVID-19 (vs non-COVID-19) and time overall and on sensitivity analyses (p < 0.0001 for all). Short-term mortality decreased over time among septic shock hospitalizations overall and for those with and without COVID-19, but compared to those without COVID-19, the relative rate of decline was faster among the former (aOR/quarter 0.93 [95% CI 0.92-0.94]), with generally similar findings on sensitivity analyses.
Conclusions: COVID-19 was associated with high short-term mortality in septic shock, persisting throughout the study period. Although short-term mortality rates decreased over time among septic shock patients with and without COVID-19, the pace of improvement was faster among the former.
