Three Major Scientific Societies Confirm Link Between SARS- CoV-2 and Sepsis, Which Causes Vast Majority of COVID-19 Deaths
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June 24, 2021 -- Sepsis is the immune system’s response to severe infections, bacterial, fungal, or viral, leading to the damage and failure of organs and death. The uptake by health systems of measures to prevent and treat sepsis, urged by the World Health Assembly in 2017,1 is more urgent than ever, as emphasized in a consensus paper published in Intensive Care Medicine2 by the Global Sepsis Alliance (GSA), the European Society for Intensive Care Medicine (ESICM), and the Society of Critical Care Medicine (SCCM).
These leading organizations emphasize the importance of recognizing that patients critically ill with COVID-19 have viral sepsis, despite some differences from sepsis caused by other pathogens. Patients with severe COVID-19 suffer from multi-organ dysfunction, including acute respiratory distress syndrome (ARDS), vasodilatory shock, acute kidney injury, coagulopathy, and impaired brain, heart, and gastrointestinal function; these represent the common clinical manifestations that characterize sepsis.
Last year a systematic review led by a research team in Athens, Greece, confirmed that COVID-19 causes death and disability due to sepsis3: 85% of adults critically affected by COVID-19 develop sepsis, 40% of the whole spectrum of cases present with sepsis.
“Sepsis should become a widely used umbrella term for a condition that is caused by different pathogens, including SARS-CoV-2”, says Tex Kissoon, GSA President. “This pandemic has showed us the effectiveness of international and horizontal cooperation between healthcare professionals and policymakers. We must keep the focus on infection prevention measures and use the successful trial platforms set up during the pandemic to support research on sepsis. Above all governments should integrate sepsis in the national health systems, as urged by the WHA resolution of 2017," concludes Kissoon.
Greg S. Martin, SCCM President, also stresses on the importance of understanding severe COVID-19 as viral sepsis: “Even before COVID-19, the global impact of sepsis was astonishing and vastly underestimated. With 150 million cases of COVID-19 leading to nearly 5 million deaths in less than 18 months, it is more important than ever to appreciate that COVID-19 may manifest as sepsis.“
Management guidelines for COVID-19 have been directly developed by the Surviving Sepsis Campaign Coronavirus Disease 2019 panel from similar sepsis guidelines4. In this regard, Martin reminds that “as with sepsis, a key element for effective treatment of patients with COVID-19 is to recognize the inciting infection and the consequent immune response in order to treat the potentially lethal organ dysfunction that accompanies COVID-19 and is the hallmark of sepsis.”
The three organizations also warns that patients who survive other forms of sepsis suffer longer- term ill-effects similar to those of patients with “long-COVID”, although they are not equally well recognized. Scientific literature demonstrates that longer-term effects of sepsis, known as post- sepsis syndrome, occur in up to 50% of sepsis survivors, who suffer from persisting physical, cognitive, and psychological sequelae.
“COVID-19 will end at some point, but ICU teams will carry on taking care of patients with sepsis. We need to raise awareness of sepsis in the community“, according to Maurizio Cecconi, ESICM President, who adds: “As with patients with long-COVID, patients who survive sepsis have a long journey ahead. Providing the best possible care for patients with sepsis means also
looking after sepsis survivors and their families in their journey to get back their lives.“ Sepsis Facts
- 50 million cases per year
- 40% are children under age 5
- 11 million deaths - burden concentrated in low- and middle-income countries
- Leading cause of death in high-income countries5
- 3,4 million cases in Europe, 680.000 deaths per year6 (e.g. >100.000 in France,7 98.000 in Germany)7
- $62 billion: average yearly cost for sepsis treatment in the United States
- €9 billion: average yearly cost for sepsis treatment in Germany (3% health budget)7 €15.000: average treatment cost for single patient in Germany9 €16.000: average treatment cost for single patient in France6
3. COVID-19 as cause of viral sepsis: A Systematic Review and Meta-Analysis
Eleni Karakike, Evangelos J. Giamarellos-Bourboulis, Miltiades Kyprianou, Carolin Fleischmann-Struzek, Mathias W. Pletz, Mihai G. Netea, Konrad Reinhart, Evdoxia Kyriazopoulou
medRxiv 2020.12.02.20242354; doi: https://doi.org/10.1101/2020.12.02.20242354; in press on Critical Care Medicine.
5. Rudd, K.E., Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. The Lancet (British edition), 2020. 395(10219): p. 200 - EOA.
6. Estrapolation from Mellhammar L, Wullt S, Lindberg Å, Lanbeck P, Christensson B, Linder A. Sepsis Incidence: A Population-Based Study. Open Forum Infect Dis. 2016;3(4):ofw207. Published 2016 Dec 8. doi:10.1093/ofid/ofw20
7. Dupuis, C., Bouadma, L., Ruckly, S. et al. Sepsis and septic shock in France: incidences, outcomes and costs of care. Ann. Intensive Care 10, 145 (2020). https://doi.org/10.1186/s13613-020-00760-x
8.Fleischmann, C., Hartmann, M., Hartog, C. et al. Epidemiology of Sepsis in Germany: Incidence, Mortality And Associated Costs of Care 2007-2013. ICMx 3, A50 (2015). https://doi.org/10.1186/2197-425X- 3-S1-A509
9. Study currently under review.