Sepsis of Patients Infected by SARS-CoV-2: Real-World Experience from the International HOPE-COVID-19-Registry and Validation of HOPE Sepsis Score (preprint)

ABSTRACT

Background: Sepsis patients with a concomitant Coronavirus (COVID-19) infection are related to a high morbidity and mortality rate. We investigated a large cohort of sepsis patients with a concomitant COVID-19 to determine clinical characteristics, laboratory and radiological findings, and predictors of mortality. We developed a risk score for the estimation of sepsis risk in patients with COVID-19.Methods: In the present study, we conducted a sub-analysis from the international Health Outcome Predictive Evaluation Registry for COVID-19 (HOPE-COVID-19-Registry). Out of 5,837 patients with COVID-19, 624 patients were diagnosed with sepsis according to the Sepsis-3 International Consensus.Findings: In multivariable analysis, the following risk factors were identified as independent predictors for developing sepsis current smoking, tachypnoea (>22 breath per minute), haemoptysis, peripheral oxygen saturation (SpO2) < 92%, blood pressure (BP) (systolic BP< 90mmHg and diastolic BP <60mmHg), Glasgow coma scale (GCS) <15, elevated procalcitonin (PCT), elevated troponin I (TnI), and elevated Creatinine > 1.5 mg/dl. By assigning odds ratio weighted points to these variables, the following three risk categories were defined to develop sepsis during admission low-risk group (probability of sepsis 3.1-11.8%); intermediate-risk group (24.8-53.8%); high-risk-group (58.3-100%). A score of 1 was assigned to current smoking, tachypnoea, decreased SpO2, decreased blood pressure, decreased GCS, elevated PCT, TnI, and creatinine, whereas a score of 2 was assigned to haemoptysis.Interpretation: The HOPE Sepsis Score including 9 parameters is useful in identifying high-risk COVID-19 patients to develop sepsis. Sepsis in COVID-19 is associated with a high mortality rate.Funding Statement Non-conditioned grant (FUNDACIÓN INTERHOSPITALARIA PARA LA INVESTIGACIÓN CARDIOVASCULAR, FIC. Madrid, Spain)Declaration of Interests We declare no competing interests.Ethics Approval Statement The study was approved by the Ethics Committee in all involved centres.