TY - JOUR
TI - Coronavirus Disease 2019 as Cause of Viral Sepsis: A Systematic Review
and Meta-Analysis*
AU - Karakike, Eleni
AU - Giamarellos-Bourboulis, Evangelos J.
AU - Kyprianou,
AU - Miltiades
AU - Fleischmann-Struzek, Carolin
AU - Pletz, Mathias W. and
AU - Netea, Mihai G.
AU - Reinhart, Konrad
AU - Kyriazopoulou, Evdoxia
JO - Pediatric Critical Care Medicine
PY - 2021
VL - 49
TODO - 12
SP - 2042-2057
PB - Lippincott, Williams & Wilkins
SN - 1529-7535
TODO - 10.1097/CCM.0000000000005195
TODO - coronavirus disease 2019; organ dysfunction; organ replacement;
Sequential Organ Failure Assessment; viral sepsis
TODO - Objective: Coronavirus disease 2019 is a heterogeneous disease most
frequently causing respiratory tract infection, which can induce
respiratory failure and multiple organ dysfunction syndrome in its
severe forms. The prevalence of coronavirus disease 2019-related sepsis
is still unclear; we aimed to describe this in a systematic review. Data
Sources: MEDLINE (PubMed), Cochrane, and Google Scholar databases were
searched based on a prespecified protocol (International Prospective
Register for Systematic Reviews: CRD42020202018). Study Selection:
Studies reporting on patients with confirmed coronavirus disease 2019
diagnosed with sepsis according to sepsis-3 or according to the presence
of infection-related organ dysfunctions necessitating organ
support/replacement were included in the analysis. The primary end point
was prevalence of coronavirus disease 2019-related sepsis among adults
hospitalized in the ICU and the general ward. Among secondary end points
were the need for ICU admission among patients initially hospitalized in
the general ward and the prevalence of new onset of organ dysfunction in
the ICU. Outcomes were expressed as proportions with respective 95% CI.
Data Extraction: Two reviewers independently screened and reviewed
existing literature and assessed study quality with the Newcastle-Ottawa
Scale and the Methodological index for nonrandomized studies. Data
Synthesis: Of 3,825 articles, 151 were analyzed, only five of which
directly reported sepsis prevalence. Noting the high heterogeneity
observed, coronavirus disease 2019-related sepsis prevalence was 77.9%
(95% CI, 75.9-79.8; I-2 = 91%; 57 studies) in the ICU, and 33.3%
(95% CI, 30.3-36.4; I-2 = 99%; 86 studies) in the general ward. ICU
admission was required for 17.7% (95% CI, 12.9-23.6; I-2 = 100%) of
ward patients. Acute respiratory distress syndrome was the most common
organ dysfunction in the ICU (87.5%; 95% CI, 83.3-90.7; I-2 = 98%).
CONCLUSIONS: The majority of coronavirus disease 2019 patients
hospitalized in the ICU meet Sepsis-3 criteria and present
infection-associated organ dysfunction. The medical and scientific
community should be aware and systematically report viral sepsis for
prognostic and treatment implications.
ER -