Sepsis of Patients Infected by SARS-CoV-2: Real-World Experience From the International HOPE-COVID-19-Registry and Validation of HOPE Sepsis Score
Mohammad Abumayyaleh, Iván J. Núñez‐Gil, Ibrahim El‐Battrawy, Vicente Estrada, Víctor Manuel Becerra‐Muñoz, Aitor Uribarri, Inmaculada Fernández‐Rozas, Gisela Feltes, Ramón Arroyo‐Espliguero, Daniela Trabattoni, Javier López País, Martino Pepe, Rodolfo Romero, María Elizabeth Ortega-Armas, Matteo Bianco, Thamar Capel Astrua, Fabrizio D’Ascenzo, Óscar Fabregat‐Andrés, Andrea Ballester, Francisco Marı́n, Danilo Buonsenso, Raúl Sánchez-Giménez, Christel Weiß, Cristina Fernández, Antonio Fernández‐Ortíz, Carlos Macaya, İbrahim Akın
Abstract
Background: Patients with sepsis with a concomitant coronavirus (COVID-19) infection are related to a high morbidity and mortality rate. We investigated a large cohort of patients with sepsis with a concomitant COVID-19, and we developed a risk score for the estimation of sepsis risk in COVID-19. Methods: We conducted a sub-analysis from the international Health Outcome Predictive Evaluation Registry for COVID-19 (HOPE-COVID-19-Registry, NCT04334291). Out of 5,837 patients with COVID-19, 624 patients were diagnosed with sepsis according to the Sepsis-3 International Consensus. Results: In multivariable analysis, the following risk factors were identified as independent predictors for developing sepsis: current smoking, tachypnoea (>22 breath per minute), hemoptysis, peripheral oxygen saturation (SpO 2 ) <92%, blood pressure (BP) (systolic BP <90 mmHg and diastolic BP <60 mmHg), Glasgow Coma Scale (GCS) <15, elevated procalcitonin (PCT), elevated troponin I (TnI), and elevated creatinine >1.5 mg/dl. By assigning odds ratio (OR) 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%); and high-risk-group (58.3–100%). A score of 1 was assigned to current smoking, tachypnoea, decreased SpO 2 , decreased BP, decreased GCS, elevated PCT, TnI, and creatinine, whereas a score of 2 was assigned to hemoptysis. Conclusions: The HOPE Sepsis Score including nine parameters is useful in identifying high-risk COVID-19 patients to develop sepsis. Sepsis in COVID-19 is associated with a high mortality rate.