Published On Jul 31, 2020
Sepsis
Global Sepsis Alliance, Can COVID-19 cause sepsis
https://www.global-sepsis-alliance.or...
COVID-19 does indeed cause sepsis
Sepsis is “a life-threatening organ dysfunction caused by a dysregulated host response to infection.”
Other organs as well as the lungs
Direct viral invasion and sepsis
Seattle area in the United States, ICU patients
Septic shock severe enough to require drugs to support the heart and circulation in almost, 70%
Liver injury, over 30% had evidence of liver injury
Depressed immune response, 75%
Acute kidney failure, 20%
Chinese data
Significant heart damage, 28%
Potentially from direct invasion of cardiac muscle by the virus
Resulting in heart failure and abnormal heart rhythms
This cardiac damage was associated with a five-fold increase in the risk of death
COVID-19 causing sepsis
Critical Care Explorations (June, 2020)
https://www.ncbi.nlm.nih.gov/pmc/arti...
Research technique
Multisystemic clinical and autopsy findings
Viral sepsis accurately describes the whole clinical picture
Pathophysiology
Intense cytokine release
Prolonged inflammation
Immunosuppression with T cell exhaustion
Lymphopenia and immunosuppression
Organ dysfunctions
Management
Optimal treatment uncertain
Supportive treatment and immunomodulators
Until effective antivirals are developed
UK Sepsis Trust
https://sepsistrust.org/covid-19-reco...
A life-threatening condition
When the body’s response to infection injures its own tissues and organs
A percentage of COVID-19 infections can result in such organ damage and subsequent failure
Therefore features in addition to respiratory failure
Acute
Chronic
Sepsis associated with infection, any of the following
Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (in a day)
Severe breathlessness
It feels like you’re going to die
Skin mottled or discoloured
Clinical observations
https://www.aafp.org/afp/2013/0701/p4...
Temperature
above 38.5 (101.3)
below 35 (95)
Heart rate above 90 / minute
Breathing more than 20 / minute
Blood sugar, above 6.6 mmo/L (118 mg/dL)
White cells high or low
CRT more than 3 seconds
AMS
Note
Breathlessness, cough and fever are common in COVID-19
Sepsis SOB
Severe breathlessness
Very short of breath at rest
Breathing very rapidly, 30 minute or more
Cannot say more than 2-3 words at a time
Cyanosis, central or peripheral
Global, regional, and national sepsis incidence and mortality,
1990–2017: analysis for the Global Burden of Disease Study (Lancet, 16 January 2020)
https://www.thelancet.com/journals/la...
In 2017
48·9 million cases of sepsis were
11 million deaths (19.7% of global deaths)
https://ourworldindata.org/what-does-...
56 million people died in 2017
1990 – 2017
37·0% reduction in incidence of sepsis
52·8% reduction in mortality
Highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia.
Post-sepsis syndrome – an evolving entity that afflicts survivors of sepsis
https://molmed.biomedcentral.com/arti...
Sequelae of sepsis
Were thought to be independent of sepsis itself
Either comorbidities or complications of critical illness
Recent studies, consistent patterns in sepsis survivors
Lasting months to years after symptoms of active sepsis resolved
Post-sepsis syndrome
Significantly increased risk of death
Poor health-related quality of life
After 2 years
50% recovery
33% died
17% post sepsis syndrome
Often the recovery is not complete
Constellation of long-term effects
Neurocognitive impairment
Functional disability
Anxiety, depression, PTSD
Psychological deficits
Metabolic effects
Organ dysfunction
Gut dysbiosis
Stroke
Myocardial infarction
Fatal coronary artery disease
Redevelopment of sepsis
Exacerbation of previous chronic illness.
Rehospitalization rate
Post sepsis infection most common reason (12%)
Mostly pneumonia
30 days, 20 - 32%
90-day, 40%
One-year, 63%