Long-term characteristics and outcomes of septic critically ill patients with and without COVID-19

Background: In-hospital mortality of septic critically ill patients with COVID-19 is significantly higher than in those without COVID-19. The knowledge on long-term outcomes remains scarce. In this retrospective analysis, we compare clinical characteristics, long-term functional outcomes, and survival in septic critically ill patients with and without COVID-19.

Methods: Data of septic critically ill patients without COVID-19 were collected as part of the Comprehensive Sepsis Center Dresden-Kreischa registry from 2020 to 2023. The data of septic critically ill patients with COVID-19 were collected as part of the local ARDS/COVID-19 registry over the same period. Diagnosis of sepsis was based on the Sepsis-3 definition. Variables collected for analyses were obtained from electronic health records. Long-term follow-up was performed 6-12 months after sepsis diagnosis. Survival was depicted using Kaplan-Meier curves. Associations between long-term mortality and risk factors were modeled by Cox Regression.

Results: 372 septic patients without COVID-19 and 301 with COVID-19 were enrolled. Septic patients with COVID-19 were significantly younger, had a significantly lower Charlson Comorbidity Index, and had a significantly higher SOFA score at ICU admission. Long-term follow-up showed a significantly higher mortality in septic patients with COVID-19 (73.4 % vs. 30.1 %; HR 3.4 (95 % CI 2.73-4.27; p < 0.05)). COVID-19 infection was associated with significant increased mortality (adjusted HR 3.27; 95 % CI 2.48-4.33; p < 0.05) and reduced health-related quality of life, measured by the EQ-5D-3 L Index, (0.56 (0.16-0.79) vs. 0.79 (0.69-0.99); p < 0.05).

Conclusions: In our cohort of septic critically ill patients, health-related quality of life and long-term survival were considerably reduced in patients with concomitant COVID-19. Furthermore, COVID-19 could be identified as an independent risk factor for higher long-term mortality in these patients.