Development of septic shock and prognostic assessment in critically ill patients with coronavirus disease outside Wuhan, China

doi:10.5847/wjem.j.1920-8642.2021.04.007

Abstract

Abstract:

BACKGROUND: The study aims to illustrate the clinical characteristics and development of septic shock in intensive care unit (ICU) patients confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and to perform a comprehensive analysis of the association between septic shock and clinical outcomes in critically ill patients with coronavirus disease (COVID-19).
METHODS: Patients confirmed with SARS-CoV-2 infection, who were admitted to the ICU of the Third People’s Hospital of Shenzhen from January 1 to February 7, 2020, were enrolled. Clinical characteristics and outcomes were compared between patients with and without septic shock.
RESULTS: In this study, 35 critically ill patients with COVID-19 were included. Among them, the median age was 64 years (interquartile range [IQR] 59-67 years), and 10 (28.4%) patients were female. The median ICU length of stay was 16 days (IQR 8-23 days). Three (8.6%) patients died during hospitalization. Nine (25.7%) patients developed septic shock in the ICU, and these patients had a significantly higher incidence of organ dysfunction and a worse prognosis than patients without septic shock.
CONCLUSIONS: Septic shock is associated with a poor outcome in critically ill COVID-19 patients and is one of the hallmarks of the severity of patients receiving ICU care. A dysregulated immune response, uncontrolled inflammation, and coagulation disorders are strongly associated with the development and progression of COVID-19-related septic shock.

Key words: Severe acute respiratory syndrome coronavirus 2, Coronavirus disease, Intensive care unit, Septic shock, Immune response

Ren-qi Yao, Chao Ren, Di Ren, Jin-xiu Li, Ying Li, Xue-yan Liu, Lei Huang, Yong Liu, Mian Peng, Yong-wen Feng, Yong-ming Yao. Development of septic shock and prognostic assessment in critically ill patients with coronavirus disease outside Wuhan, China[J]. World Journal of Emergency Medicine, 2021, 12(4): 293-298.

Figures/Tables 1

References 25

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Characteristics	Septic shock (n=9) Non-septic shock (n=26) P-value
Demographic characteristics
Age, years, median (IQR)	65.0 (60.0-69.0)	63.0 (59.0-66.3)	0.446
Female, n (%)	3 (33.3)	7 (26.9)	0.694
Complications, n (%)
ARDS	9 (100.0)	25 (96.2)	0.437
Secondary infection	9 (100.0)	7 (26.9)	<0.001
Acute kidney injury	5 (55.6)	2 (7.7)	0.003
Acute cardiac injury	3 (33.3)	0 (0)	0.003
Acute liver injury	3 (33.3)	0 (0)	0.003
Coagulopathy	3 (33.3)	0 (0)	0.003
Treatments
IMV, n (%)	9 (100.0)	9 (34.6)	<0.001
MV duration, days, median (IQR)	25.1 (18.6-29.3)	7.4 (4.8-11.4)	<0.001
ECMO, n (%)	4 (44.4)	0 (0)	<0.001
Vasoactive agents, n (%)	9 (100.0)	1 (3.8)	<0.001
Prognosis
Onset of symptoms to hospital admission, days, median (IQR)	6.0 (2.0-10.5)	4.0 (2.8-7.0)	0.469
Hospital admission to ICU admission, days, median (IQR)	9.0 (3.0-10.5)	6.5 (3.0-9.3)	0.590
Onset of ICU admission to septic shock, days, median (IQR)	5.0 (3.0-7.0)	NA	NA
Length of stay in hospital, median, days, median (IQR)	33.0 (28.5-34.5)	29.5 (23.0-32.3)	0.086
Length of stay in ICU, days, median (IQR)	24.0 (23.0-26.0)	10.0 (6.0-17.5)	<0.001
Discharge from hospital, n (%)	0 (0)	4 (15.4)	0.110
Discharge from ICU, n (%)	4 (44.4)	26 (100.0)	<0.001
Death, n (%)	3 (33.3)	0 (0)	0.003

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