The Relationship Between Sepsis and COVID-19: What We Know

By the bioMérieux Connection Editors

The Global Sepsis Alliance has stated that COVID-19 can cause sepsis, the body’s overwhelming and life-threatening response to an infection that can lead to organ damage and death. In the U.S., one in three patients who die in a hospital die of sepsis. Many different types of infections can cause sepsis, but the most common cause is pneumonia. Pneumonia is severe lung inflammation that occurs in response to an infection in which the air sacs fill with pus, making it difficult to breathe. Bacterial, viral and fungal infections can cause pneumonia and therefore sepsis.

Research suggests that COVID-19 may lead to sepsis due to several variables, including direct viral invasion, the presence of a bacterial or viral co-infection, and/or the age of the patient.

Two published case series about patients with severe COVID-19 from the Seattle, WA, area reported septic shock severe enough to require drugs to support the heart and circulation in almost 70% of patients. The overall organ damage among these patients was also substantial. More than 30% of patients in one series had evidence of liver injury and 75% had evidence of a depressed immune response. The other series reported acute kidney failure in almost 20% of affected patients requiring ICU care. In these studies, the great majority of patients tested negative for co-infection of bacteria and viruses. The lack of bacterial or viral co-infection suggests that the observed septic shock and/or organ damage may have been directly related to SARS-CoV-2.

While viral sepsis is a possible complication of SARS-CoV-2, viral infections alone generally do not cause sepsis as frequently as bacterial infections do. For example, seasonal influenza is commonly associated with bacterial co-infection that leads to severe illness. It is typically this kind of severe illness that requires admission to the ICU and causes ventilator-associated pneumonia. Often times, flu-associated bacterial co-infection is caused by pathogens that colonize in the nasopharynx—the upper part of the throat that sits behind the nose. Common bacterial pathogens that lead to pneumonia and sepsis include staphylococcus and streptococcus. From the case series previously discussed, COVID-19 may differ from seasonal influenza, causing sepsis more often by itself, rather than from a bacterial co-infection.

However, other data suggest that co-infection with COVID-19 may be more common. A study published in April 2020 investigated the co-infection rates between SARS-CoV-2 and other respiratory pathogens and found that more than 20% of positive SARS-CoV-2 specimens also tested positive for one or more non-SARS-CoV-2 pathogens. These specimens came from symptomatic patients, with symptoms ranging in severity. A retrospective study of hospitalized COVID-19 patients found an even greater likelihood of co-infection. The study showed that, of patients who did not survive, half had experienced a secondary infection. Of the non-survivors, 100% of patients had sepsis and 70% were noted to have septic shock.

In the case of COVID-19, the virus’s effect on the body as a whole and its relationship to sepsis are not yet well understood. This may be due to inconsistent testing for secondary pathogens and because researchers are still trying to determine what the best care and treatments are for COVID-19. While certain treatments seem promising, such as convalescent plasma, dexamethasone, or the antiviral treatment, remdesivir, they are still experimental. The current health of the patient, age, and presence of co-morbidities can also play a role in patient outcomes. Overall, COVID-19 can have a vast impact on virtually all organ systems, and the severity of its impact on the organs is directly associated with survival. Even though researchers are still investigating the relationship between COVID-19 and sepsis, proper care for sepsis in patients with severe COVID-19 remains very important.

Opinions in this article are not necessarily those of bioMérieux, Inc.

18 Replies to “The Relationship Between Sepsis and COVID-19: What We Know”

  1. I was hospitalized for 5 days from severe sepsis of unknown origin. I was so weak by the time I got to the hospital, I could hardly move, could hardly breathe. I was in a state of mental confusion and my body was shuddering, not shivering uncontrollably. When I was released from the hospital I actually thought I was there about 24 hours but found out I had been there 5 days. I have never been so sick in my life. Prior to this I was a healthy active 60 year old woman, I feel as if I aged 20 years in just a week’s time. It has taken a long, long time for me to start feeling normal–if that’s what you call it. I don’t think I have or ever will recover fully. I now have regular insomnia, mental confusion, chronic pain and fatigue related to PSS (post sepsis syndrome). This is very much like the symptoms people have after surviving severe Covid. Like Long Covid. The interesting part is that this all occurred at least a year before the Covid pandemic hit. I have a fear of Covid that has caused me to isolate myself from the world to the point of stopping work. I am a teacher and fear I will catch Covid in the school environment. I don’t leave home unless I absolutely have to. It’s frightening and lonely.

  2. My 86yr old mother just passed two weeks after Christmas…the death certificate says she died from Septic shock, MRSA & Covid. She had been in pain for so many years & it was extremely difficult to watch her deteriorate.

    1. Thats what my husband’s death was attributed to when he passed away 3 months later in hospital. The nurse told me he was being treated for covid pneumonia and was given all antibiotics thats patients who test positive were given.he had 9 negative tests over 3 months period, but died of Cdiff that often occurs after these or other antibiotics? Why was he given these drugs with negative tests?they can’t put covid as part of his death because of negative tests. But they said his chest xray and other symptoms were same as covid.he was diagnosed with infiltrate pneumonia and needed very heavy oxygen. I say if they treated him as a covid patient he should be eligible to have funeral paid for by covid funeral plan, inside of cdiff that was caused by all covid and other antibiotics he was given

  3. My Mother tested positive for Covid this January 2021..and passed away in march.. her death certificate does not state she died from Covid or complications due to Covid.. it says natural causes and Sepsis was one of the causes recorded on the certificate. If she had not contracted Covid she wouldn’t have died from Sepsis, inactive endocarditis, E faecalis bacteremia and intercranial hemorrhage. She was actively fine until she contracted Covid. Why is Covid not even mentioned on death certificate? I really desperately want a Physician’s help regarding her case.

    1. My 36 year old Son died from Covid on Oct 3, 2021& he had COVID19 pneumonia, than MRSA Pneumonia, he was on a Ventilater and was Medically Paralyzed, we watched him through a glass door for fourteen days. Had wait for Infection Control to even allow this. But his Death Certificate stated he passed from COVID19.

  4. The first week in February 2020, I hadn’t been feeling well, very fatigued and had a steady low grade temp. I went to my doctor. She said, with the symptoms I was having she thought I might have pneumonia. She sent me for blood work and a chest X-ray. She called that evening and told me that I had the beginning of pneumonia. She called in an antibiotic. Two days later, I’m sleeping and I wake up feeling really sick. I was so weak that it took everything for me to get my blood oxygen finger thingy to check my blood ox. I can’t tell you what it was bc I was kind of out of it, confused. Then, as I’m laying there, I start shaking. It was different then shivering, it was stronger. I couldn’t control it. I thought it was shivering but it was rigors. My husband wakes up to get ready for work and realizes I’m in the guest room. He asked what was wrong bc I looked so pale, he could see me shaking but we both thought I was shivering. He took my temp. I was running a fever so he said he would keep an eye on me. He called the doctor. She said if I wasn’t better by tomorrow or the next day, then she should see me. My husband checked my blood ox and it was 76!! He said, come on, we’re going to the hospital. He put me on his oxygen that he uses for cluster headaches. I get to the hospital. I could barely breathe on my own. They checked me for the flu and it was negative. They checked to see if I had gone septic and I had. I also had pneumonia in both my lungs. It was bad. They admitted me. They had me on IV antibiotics but they weren’t really helping, they also had me on steroids and oxygen. All I could do was sleep and sometimes I couldn’t do that bc I was miserable. I was in the hospital for 5 days. The Hospitalist believed that my double pneumonia was caused by a virus and I was sent home with oxygen. I have not felt well since this happened to me. I have complete exhaustion, been sick pretty much since that happened. A few of my doctors believe I had Covid 19. I asked my primary care doctor if I could be tested for the antibody and at first he said, I don’t know how accurate they are. Then he said, really, what difference does it make whether you had it or not. You don’t have it now. No one has considered that being sick this long could have anything to do with my double pneumonia, gone septic. I get so frustrated. I know that I have to be my own advocate but it’s getting someone to listen to me and consider the long term effects this may have had on my body. I know something is wrong. I feel it. Prayers and wishing all of you who have and are suffering, some relief and back to good health. By the way, I am 51 years old. 

    1. I am so sorry you have been thru all that. I developed cellulitis where I received my shot. I went my regular doctor. He told me the shot was working. Next day I went to a prompt care. That knew what was wrong. Gave me a presdione shot and antibiotics for been days. Will be thing about you.

    2. This is interesting; I tried to get an antibody test as well and the doctor tried to discourage it. I ended up not getting it cause I was in for a covid test; if the test came up positive, why chock up the money for an antibody test? But he said similar things, like it didn’t matter, and that they don’t have proof that the antibodies mean anything. Which didn’t make sense to me at all. 

    3. My brother passed March due to sepsis. Had covid prior to the sepsis. Now his insurance doesn’t want to pay his policy with no explanation. Does not meet criteria. Sad that he looked ahead for his family only 1 child with grandkids to deny them the little payment they are due.

    4. Wow! Your story sound like mine. I been in the hospital since December 26 first for Covid pneumonia almost died now for Covid sepsis I’m afraid they will release before time, I’m praying.

  5.  In 2017 I was taken from my home in a semi Comatose state, and taken to the emergency room.where they had a very difficult figuring out what was wrong with me.They came to the conclusion that I had a severe case of Sepsis, and my Kidneys and other organs were failing rapidly. They tried several Antibiotics,with little or no positive effect, and kept saying how my case of Sepsis was acting differently than most cases of Sepsis.It was attacking my organs first it was my kidneys then it attacked my Intestines, and finally it left me with Pneumonia, just as the Hospital I was in got the word from medicare that my Medicare Allowed Hospital days were up and I had to leave, even with Pneumonia, So I got shipped off to a Re-Habilitation / Nursing Home. After lying in a Hospital Bed for 2 months my leg mussels suffered severely. I can’t help think did I actually have a less contagious case of Covo 19 and not sepsis, who knows how long the Covo19 has been around. I have been suffering from Post something Syndrome ever sence 2017 and if it turns out to be a post Covo19 Syndrome ! I think, not just our Country but the World is in very deep trouble,the scary part about this Post whatever that it dose not come on right away. 


    1. Post Sepsis Syndrome (PSS) and it doesn’t come right away so we don’t see the correlation until it’s horrible. Please put the word out. That’s what I am trying to do.

  6. Since drs are so busy I don’t think they really have time to focus on proper diagnoses. I’m not faulting them; just saying. Last year 2019 I realized my nose running was constant and took napkins everywhere.also I lost my sense of smell.. not taste, and my hair was filling out so much that people complained when I came to their house that they could see my hair on their floor. In Feb 2020 my spouse & I had what felt like flu. It came on like a freight train suddenly but I had had a flu shot and just thought oh well my bad luck. Then in March when it didn’t go away I told my doctor and he sent me to get a chest x-ray. Then he said I had pneumonia and gave me an antibiotic that would work for it and some prednisone soon I was not congested anymore but during that time I really thought I was going to die I felt so horrible and had so much congestion I was 71. Since March I have been so tired and weak that I have stayed in bed almost all the time . I have to force myself to get up and walk around because the longer I stay in bed the harder it is to get hair is falling out so much that I ordered some special biotin shampoo I used to have beautiful thick hair and now I have only a very small amount. I’m now 72.I asked my doctor to refer me to a thyroid specialist because my mother had had thyroid cancer and my hair is falling out so badly and I’m so tired.I also have night terrors where I wake up and actually believe I’m being attacked. I had to hide the scissors and knives from my bedroom because I’ve pounded on my husband’s back at night, and once I actually threw myself onto the floor because I was dreaming that I was in a car crash. A week ago my family doctor gave me an order to take for blood work I want to know if I have had covid. he seems to think I may have. I want to know if there is a an antibody test that is actually reliable and I’m so stressed and upset I just want to vent to you so thank you. I don’t know if it matters but I also had sepsis years ago.. not the viral kind.

    1. Your symptoms sound similar to my Mother’s experience (including the night terrors). She has Parkinson’s Disease. Please don’t panic, but maybe read up on it and compare your own symptoms accordingly. Please take care

Leave a Reply

Your email address will not be published. Required fields are marked *