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Sepsis Global Sepsis Alliance, Can COVID-19 cause sepsis https://www.global-sepsis-alliance.org/news/2020/4/7/update-can-covid-19-cause-sepsis-explaining-the-relationship-between-the-coronavirus-disease-and-sepsis-cvd-novel-coronavirus COVID-19 does indeed cause sepsis Sepsis is “a life-threatening organ dysfunction caused by a dysregulated host response to infection.” Other organs as well as the lungs Direct viral invasion and sepsis Seattle area in the United States, ICU patients Septic shock severe enough to require drugs to support the heart and circulation in almost, 70% Liver injury, over 30% had evidence of liver injury Depressed immune response, 75% Acute kidney failure, 20% Chinese data Significant heart damage, 28% Potentially from direct invasion of cardiac muscle by the virus Resulting in heart failure and abnormal heart rhythms This cardiac damage was associated with a five-fold increase in the risk of death COVID-19 causing sepsis Critical Care Explorations (June, 2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314326/ Research technique Multisystemic clinical and autopsy findings Viral sepsis accurately describes the whole clinical picture Pathophysiology Intense cytokine release Prolonged inflammation Immunosuppression with T cell exhaustion Lymphopenia and immunosuppression Organ dysfunctions Management Optimal treatment uncertain Supportive treatment and immunomodulators Until effective antivirals are developed UK Sepsis Trust https://sepsistrust.org/covid-19-recovery-response/ A life-threatening condition When the body’s response to infection injures its own tissues and organs A percentage of COVID-19 infections can result in such organ damage and subsequent failure Therefore features in addition to respiratory failure Acute Chronic Sepsis associated with infection, any of the following Slurred speech or confusion Extreme shivering or muscle pain Passing no urine (in a day) Severe breathlessness It feels like you’re going to die Skin mottled or discoloured Clinical observations https://www.aafp.org/afp/2013/0701/p44.html Temperature above 38.5 (101.3) below 35 (95) Heart rate above 90 / minute Breathing more than 20 / minute Blood sugar, above 6.6 mmo/L (118 mg/dL) White cells high or low CRT more than 3 seconds AMS Note Breathlessness, cough and fever are common in COVID-19 Sepsis SOB Severe breathlessness Very short of breath at rest Breathing very rapidly, 30 minute or more Cannot say more than 2-3 words at a time Cyanosis, central or peripheral Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study (Lancet, 16 January 2020) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32989-7/fulltext In 2017 48·9 million cases of sepsis were 11 million deaths (19.7% of global deaths) https://ourworldindata.org/what-does-the-world-die-from 56 million people died in 2017 1990 – 2017 37·0% reduction in incidence of sepsis 52·8% reduction in mortality Highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia. Post-sepsis syndrome – an evolving entity that afflicts survivors of sepsis https://molmed.biomedcentral.com/articles/10.1186/s10020-019-0132-z Sequelae of sepsis Were thought to be independent of sepsis itself Either comorbidities or complications of critical illness Recent studies, consistent patterns in sepsis survivors Lasting months to years after symptoms of active sepsis resolved Post-sepsis syndrome Significantly increased risk of death Poor health-related quality of life After 2 years 50% recovery 33% died 17% post sepsis syndrome Often the recovery is not complete Constellation of long-term effects Neurocognitive impairment Functional disability Anxiety, depression, PTSD Psychological deficits Metabolic effects Organ dysfunction Gut dysbiosis Stroke Myocardial infarction Fatal coronary artery disease Redevelopment of sepsis Exacerbation of previous chronic illness. Rehospitalization rate Post sepsis infection most common reason (12%) Mostly pneumonia 30 days, 20 - 32% 90-day, 40% One-year, 63%

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