Clinical Outcomes and Hospital Resource Utilization Among Patients with Sepsis and COVID-19 Infection: Insights from the United States National Inpatient Sample Analysis, 2020–2022

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Abstract
Clinical studies have shown that patients who had sepsis with COVID-19 infection had worse clinical outcomes, however, there is a paucity of data on the nationwide impact of COVID-19 infection in patients with sepsis. Hence, we conducted a retrospective cohort study using the National Inpatient Sample (NIS) database from 2020 through 2022 to determine the impact of COVID-19 infection on the outcomes of patients with sepsis. Adult sepsis hospitalizations were identified using ICD-10-CM codes and stratified by concurrent COVID-19 infection status. Survey weighted multivariate regression analysis was performed. Patients with sepsis with concurrent COVID-19 infection had worse outcomes with higher mortality rate (15.6% vs 5.4%; aOR 3.71; 95% CI 3.62-3.80), higher need for invasive ventilation (13.1% vs 6.5%) and NIV (non-invasive ventilation) (10.2% vs 4.9%), higher incidence of acute kidney injury (37.6% vs 36.7%), acute respiratory failure (57.5% vs 20.3%), acute liver failure (1.0% vs 1.2%), disseminated intravascular coagulation (DIC) (0.4% vs 0.3%), cardiac arrest (3.1% vs 1.5%), acute respiratory distress syndrome (ARDS) (7.9% vs 0.4%), higher need for renal replacement therapy (4.9% vs 4.5%), tracheostomy (1.6% vs 0.6%), extra corporeal membrane oxygenation (ECMO) (0.2% vs 0.04%), longer length of hospital stay (10.3 days vs 7.6 days), higher total charges ($127,632 vs $93,735 respectively). The results demonstrate that the COVID-19 infection was independently associated with worse clinical outcomes among hospitalized with sepsis. These results underscore the need for early recognition, aggressive treatment, and targeted therapy in this high-risk clinical group.

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