COVID-19-Related Sepsis: A Higher Mortality Rate Uncovered

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COVID-19-Related Sepsis: A Higher Mortality Rate Uncovered

COVID-19-Related Sepsis: A Higher Mortality Rate Uncovered.

New Research Reveals Higher Incidence of Sepsis Than Previously Thought.

A comprehensive study from Norway has revealed a higher incidence of sepsis cases than previously reported, with 250 cases of sepsis per 100,000 people in Norway annually.

This research challenges claims of increased reporting, showing a sharp decrease in in-hospital mortality related to sepsis and highlighting the rise in recurrent sepsis cases, especially among the elderly.

The primary reason for the increase in cases is patients experiencing recurrent sepsis rather than succumbing to it upon the first infection.

Sepsis, sometimes informally referred to as “blood poisoning,” is a severe condition, and approximately 3,000 people die from sepsis in Norwegian hospitals each year.

COVID-19-Related Sepsis: A Higher Mortality Rate Uncovered

Contrary to its colloquial name, sepsis is not actually poisoning of the blood. Sepsis occurs when the immune system reacts excessively to infections from bacteria, viruses, fungi, or parasites, leading to damage to the body’s organs and organ failure.

A new study, involving 300,000 cases of sepsis hospitalizations, has found a higher incidence of the disease than previously thought. However, a significantly higher number of patients are surviving, and the main reason for the increase in cases is that more people are experiencing recurrent sepsis, rather than succumbing to it upon their first infection.

Lise Tuset Gustad, a researcher from the Norwegian University of Science and Technology (NTNU), Nord University, and Levanger Hospital, stated, “Every year, 250 people out of every 100,000 in Norway contract sepsis for the first time. This can be seen from the age-adjusted average incidence rate. The incidence rate remained stable throughout the study but was higher than previous research results.”

A research group from the Norwegian National Centre for Sepsis at NTNU conducted a nationwide registry study, ensuring high data quality. As far as the researchers know, this is the first nationwide study on sepsis conducted over such an extended period, including all hospitalized patients, not just those requiring intensive care.

They discovered that between 2008 and 2021 (including 2021), 317,705 people were hospitalized for sepsis. Notably, at least 222,832 patients were hospitalized for sepsis for the first time.

Lise Tuset Gustad served as the primary academic advisor for Nina Vibeche Skei during her doctoral studies, and Skei is an anesthesiologist at Levanger Hospital.

This study contradicts the notion that the increase in sepsis cases is due to improved awareness of the disease and, consequently, increased reporting. Skei, the lead author of the paper, stated, “From 2008 to 2021 (including 2021), the proportion of first-time sepsis cases per 100,000 residents remained stable.”

Sharp Decline in Mortality

The study also found a significant increase in survival rates. Skei explained, “During this period, the mortality rate for patients hospitalized for the first time with sepsis decreased by at least 43%. The overall hospital mortality rate for sepsis, whether patients had it for the first time or had previous episodes, decreased by one-third. The reduced mortality rate may be due to increased awareness of the disease and updated treatment guidelines.”

In the first two years of the Covid-19 pandemic, there was a decrease in the number of people hospitalized for sepsis as a first-time infection. Researchers believe this may be related to social distancing, resulting in reduced infections in the overall population.

“We also found a decrease in the number of people aged 70 and above being hospitalized for sepsis. This may be due to the immense pressure on hospitals, prioritizing certain patient groups,” Tuset Gustad said. “Compared to normal years, these priorities led to many elderly individuals aged 70 and above not receiving hospital treatment during the pandemic, resulting in an increase in sepsis mortality, especially in 2021.”

Covid-19 raised awareness of the possibility of infections leading to organ failure. Many people were alarmed by the sight of patients on ventilators in intensive care units, first in Wuhan, then in Italy, and eventually in Norway. Bacterial and viral infections can lead to organ failure in some patients because their immune systems overreact to the infection. These patients may subsequently develop sepsis, an infection accompanied by organ failure.

“Covid-19 brought sepsis into the spotlight. Before the pandemic, people had limited knowledge of sepsis caused by viral infections. The emergence of the SARS-CoV-2 virus increased awareness of sepsis caused by this virus and sepsis in general,” Skei said.

Higher Mortality Rates Due to Covid-19

“In 2020 and 2021, 30,000 people were hospitalized for sepsis, and among them, 2,845 were hospitalized for sepsis caused by Covid-19. This accounts for approximately 10%,” Skei stated.

Nearly 90% of first-time sepsis patients were due to causes other than Covid-19 (including during the pandemic). However, a higher proportion of those with first-time sepsis caused by Covid-19 died,” Skei noted.

Rising Recurrent Sepsis Cases

Data also reveals that more people are experiencing recurrent sepsis compared to the past.

During this period, there was an increase in the number of people hospitalized for recurrent sepsis. Skei stated, “The main reason for this increase is that the number of patients aged 60 and above experiencing recurrent sepsis has doubled.”

Compared to 2008, the number of people aged 80 and above experiencing recurrent sepsis in 2021 increased by more than five times.

The likely reasons are improvements in the treatment of other diseases, such as cancer, and increased longevity. Patients with weakened immune systems and older individuals are more susceptible to initial and recurrent sepsis infections.

As a result, the study’s findings contradict the beliefs of many professionals who thought the increase in sepsis cases was due to changes in sepsis diagnosis coding. However, this is not the case.

The same sepsis diagnosis coding was used throughout the entire study period, confirming that these results reflect real changes. These findings may be unique to both Norway and the world. Previous studies in Norway were relatively outdated, with the latest study using data from 2011 and 2012, providing only a two-year snapshot of sepsis trends. In contrast, this study examined 14 years of sepsis trends.

Tuset Gustad said, “The ability to distinguish between first-time sepsis and recurrent sepsis is unique on a global scale, thanks to Norway’s excellent medical registration system.”

“Our research findings should have an impact on clinical physicians, policymakers, and healthcare planners. The burden caused by sepsis is greater than previously thought within the research community. However, we particularly need to focus on the substantial increase in the number of patients experiencing recurrent sepsis and determine preventive measures for this patient group,” Skei noted. “Healthcare policymakers should take these results into consideration. We need to make efforts to prevent recurrent sepsis,” Tuset Gustad concluded.