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.

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

  1. 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. 

  2.  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. 

       

  3. 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 around.my 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.

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