What question did this study set out to answer?

This research aims to investigate how COVID-19 influences short-term mortality in patients with septic shock over time.

March 26, 2026

263: Trends in the Prognostic Impact of Covid-19 in Septic Shock

ELEdgar Luna LandaThe University of Texas of the Permian Basin JGJohn GarzaJames S. McDonnell Foundation AMAngel M. MoralesAmerican Academy of Cosmetic Surgery

Key Points

This research aims to investigate how COVID-19 influences short-term mortality in patients with septic shock over time.
Analyzed statewide hospitalization data for septic shock patients in Texas from April 2020 to December 2023.
Defined COVID-19 and septic shock using ICD-10 codes R6521 and U071.
Applied hierarchical logistic models to assess the association of time with short-term mortality.
Included interactions between COVID-19 status and time in the analyses.
17.5% of the 246,026 septic shock hospitalizations had COVID-19.
Short-term mortality rates for septic shock were 67.0% for COVID-19 patients and 41.1% for non-COVID-19 patients overall.
In the last quarter of 2023, mortality was 45.1% for COVID-19 and 39.4% for non-COVID-19 patients.
COVID-19 was associated with a significantly higher risk of short-term mortality (aOR 4.26).
Mortality rates decreased over time, with a faster decline for patients with COVID-19 compared to those without.

Abstract

Introduction: COVID-19 was associated with high mortality in sepsis and septic shock during the early pandemic period. However, mortality in COVID-19-associated sepsis was reported to decrease over time, becoming similar to that of non-COVID sepsis on indirect comparisons. We examined the population-level trends in the association of COVID-19 with short-term mortality in septic shock. Methods: We used statewide data to identify hospitalizations aged 18 years or older with septic shock in Texas between 04/1/2020 and 12/31/2023. Septic shock and COVID-19 were defined using ICD-10 codes R6521 and U071, respectively. Hierarchical logistic models were used to estimate the association of time (quarters) with short-term mortality (in-hospital death or discharge to hospice) among septic shock hospitalizations. Interaction terms were included between COVID-19 status (with non-COVID as reference) and time overall and on sensitivity analyses among those aged ≥65 years and the mechanically ventilated. Results: Among 246,026 hospitalizations with septic shock, 17.5% had COVID-19. Compared to those without COVID-19, those with COVID-19 were younger (aged ≥65 years 53.7% vs 57.7%), but more commonly mechanically ventilated (50.1% vs 26.5%) (p < 0.0001 for both comparisons). Short-term mortality among septic shock hospitalizations with and without COVID-19 was 67.0% vs 41.1% overall and 45.1% vs 39.4% during the last quarter of 2023, respectively. On adjusted analyses, COVID-19 was associated with increased short-term mortality (adjusted odds ratio aOR 4.26 95% CI 3.84-4.32). There were significant interactions between COVID-19 (vs non-COVID-19) and time overall and on sensitivity analyses (p < 0.0001 for all). Short-term mortality decreased over time among septic shock hospitalizations overall and for those with and without COVID-19, but compared to those without COVID-19, the relative rate of decline was faster among the former (aOR/quarter 0.93 95% CI 0.92-0.94), with generally similar findings on sensitivity analyses. Conclusions: COVID-19 was associated with high short-term mortality in septic shock, persisting throughout the study period. Although short-term mortality rates decreased over time among septic shock patients with and without COVID-19, the pace of improvement was faster among the former.

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