Oud Lavi, Garza John
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
Department of Mathematics, The University of Texas of the Permian Basin, Odessa, TX, USA.
J Clin Med Res. 2023 Jun;15(6):328-331. doi: 10.14740/jocmr4937. Epub 2023 Jun 29.
Coronavirus disease 2019 (COVID-19)-related organ dysfunction is increasingly considered as sepsis of viral origin. In recent clinical and autopsy studies, sepsis has been present in the majority of decedents with COVID-19. Given the high mortality toll of COVID-19, sepsis epidemiology would be expected to be substantially transformed. However, the impact of COVID-19 on sepsis-related mortality at the national level has not been quantified. We aimed to estimate the contribution of COVID-19 to sepsis-related mortality in the USA during the first year of the pandemic.
We used the Centers for Disease Control Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) Multiple Cause of Death dataset to identify decedents with sepsis during 2015 - 2019, and those with a diagnosis of sepsis, COVID-19, or both in 2020. Negative binomial regression was used on the 2015 - 2019 data to forecast the number of sepsis-related deaths in 2020. We then compared the observed vs. predicted number of sepsis-related deaths in 2020. In addition, we examined the frequency of a diagnosis of COVID-19 among decedents with sepsis and the proportion of a diagnosis of sepsis among decedents with COVID-19. The latter analysis was repeated within each of the Department of Health and Human Services (HHS) regions.
In 2020, there were 242,630 sepsis-related deaths, 384,536 COVID-19-related deaths, and 35,807 deaths with both in the USA. The predicted number of sepsis-related deaths for 2020 was 206,549 (95% confidence interval (CI): 201,550 - 211,671). COVID-19 was reported in 14.7% of decedents with sepsis, while a diagnosis of sepsis was reported in 9.3% of all COVID-19-related deaths, ranging from 6.7% to 12.8% across HHS regions.
A diagnosis of COVID-19 was reported in less than one in six of decedents with sepsis in 2020, with corresponding less than one in 10 diagnoses of sepsis among decedents with COVID-19. These findings suggest that death certificate-based data may have substantially underestimated the toll of sepsis-related deaths in the USA during the first year of the pandemic.
2019年冠状病毒病（COVID-19）相关的器官功能障碍越来越被视为病毒源性脓毒症。在最近的临床和尸检研究中，大多数COVID-19死者都存在脓毒症。鉴于COVID-19的高死亡率，预计脓毒症流行病学将发生重大变化。然而，COVID-19对国家层面脓毒症相关死亡率的影响尚未得到量化。我们旨在估计在大流行的第一年，COVID-19对美国脓毒症相关死亡率的贡献。
我们使用疾病控制中心广泛的在线流行病学研究数据（CDC WONDER）多死因数据集，确定2015 - 2019年期间的脓毒症死者，以及2020年诊断为脓毒症、COVID-19或两者皆有的死者。对2015 - 2019年的数据进行负二项回归，以预测2020年脓毒症相关死亡人数。然后我们比较了2020年观察到的与预测的脓毒症相关死亡人数。此外，我们检查了脓毒症死者中COVID-19诊断的频率，以及COVID-19死者中脓毒症诊断的比例。后一项分析在卫生与公众服务部（HHS）的每个区域内重复进行。
2020年，美国有242,630例脓毒症相关死亡、384,536例COVID-19相关死亡以及35,807例两者皆有的死亡。2020年脓毒症相关死亡的预测人数为206,549（95%置信区间（CI）：201,550 - 211,671）。脓毒症死者中有14.7%报告患有COVID-19，而所有COVID-19相关死亡中有9.3%报告诊断为脓毒症，在HHS各区域中这一比例从6.7%到12.8%不等。
2020年，脓毒症死者中报告患有COVID-19的不到六分之一，相应地，COVID-19死者中诊断为脓毒症的不到十分之一。这些发现表明，基于死亡证明的数据可能大大低估了大流行第一年美国脓毒症相关死亡的人数。
