Risk factors for the early development of septic shock in patients with severe COVID-19


Cite item

Full Text

Abstract

Aim. In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19.

Materials and methods. We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure.

Results. We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.0±13.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.53–3.67; p<0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.76–2.70).

Conclusion. The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

About the authors

P. V. Glybochko

Sechenov First Moscow State Medical University (Sechenov University)

Email: Avt420034@yahoo.com
ORCID iD: 0000-0002-5541-2251

акад. РАН, д.м.н., проф., ректор.

Russian Federation, Moscow

V. V. Fomin

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-2682-4417

чл.-кор. РАН, д.м.н., проф., проректор по клинической работе и дополнительному профессиональному образованию

Russian Federation, Moscow

S. V. Moiseev

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-7232-4640

д.м.н., проф., зав. каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

S. N. Avdeev

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: avt420034@yahoo.com
ORCID iD: 0000-0002-5999-2150

чл.-кор. РАН, д.м.н., проф., зав. каф. пульмонологии, гл. внештат. специалист-пульмонолог Минздрава России

Russian Federation, Moscow

A. G. Yavorovskiy

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0001-5103-0304

д.м.н., ст. науч. сотр. по специальности «Анестезиология и реаниматология», зав. каф. анестезиологии и реаниматологии

Russian Federation, Moscow

M. Yu. Brovko

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0003-0023-2701

к.м.н., зам. глав. врача по медицинской части УКБ №3

Russian Federation, Moscow

K. T. Umbetova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0003-0902-9267

д.м.н., проф., каф. инфекционных болезней

Russian Federation, Moscow

V. A. Aliev

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-2089-7076

к.м.н., ассистент каф. анестезиологии и реаниматологии

Russian Federation, Moscow

E. L. Bulanova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0001-5043-6994

к.м.н., доц. каф. анестезиологии и реаниматологии

Russian Federation, Moscow

I. B. Bondarenko

Sechenov First Moscow State Medical University(SechenovUniversity)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-5536-9388

к.м.н., ассистент каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

O. S. Volkova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-4568-1298

к.м.н., дир. Клинического центра

Russian Federation, Moscow

V. V. Gaynitdinova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0001-9928-926X

д.м.н., проф. каф. пульмонологии

Russian Federation, Moscow

T. Yu. Gneusheva

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-7232-4640

к.м.н., ассистент каф. пульмонологии

Russian Federation, Moscow

K. V. Dubrovin

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-4677-0508

к.м.н., ассистент каф. анестезиологии и реаниматологии

Russian Federation, Moscow

V. A. Kapustina

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0001-6512-1629

к.м.н., доц. каф. факультетской терапии №1

Russian Federation, Moscow

V. V. Kraeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0003-2141-6411

к.м.н., ассистент каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

Z. M. Merzhoeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-3174-5000

к.м.н., ассистент каф. пульмонологии

Russian Federation, Moscow

G. S. Nuralieva

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-4726-4906

к.м.н., доц. каф. пульмонологии

Russian Federation, Moscow

P. V. Nogtev

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-5553-0880

к.м.н., ассистент каф. анестезиологии и реаниматологии

Russian Federation, Moscow

V. V. Panasyuk

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-7232-4640

к.м.н., глав. врач УКБ №3, засл. врач РФ

Russian Federation, Moscow

M. E. Politov

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0003-0623-4927

к.м.н., доц. каф. анестезиологии и реаниматологии

Russian Federation, Moscow

A. M. Popov

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0001-6739-249X

к.м.н., ассистент каф. анестезиологии и реаниматологии

Russian Federation, Moscow

E. N. Popova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0001-5164-4621

д.м.н., каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

N. A. Raspopina

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-6546-6536

д.м.н., проф. каф. пульмонологии

Russian Federation, Moscow

V. V. Royuk

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-4966-3767

к.м.н., глав. врач УКБ №1, ассистент каф. общественного здоровья и здравоохранения им. Н.А. Семашко

Russian Federation, Moscow

Yu. D. Sorokin

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-0926-4833

зав. отд-нием реанимации №1 УКБ №3

Russian Federation, Moscow

N. V. Trushenko

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-7232-4640

к.м.н., ассистент каф. пульмонологии

Russian Federation, Moscow

E. Yu. Khalikova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-6931-1494

к.м.н., доц. каф. анестезиологии и реаниматологии

Russian Federation, Moscow

N. A. Tsareva

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-5448-9222

к.м.н., доц. каф. пульмонологии

Russian Federation, Moscow

S. Yu. Chikina

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-5536-9388

к.м.н., ассистент каф. пульмонологии

Russian Federation, Moscow

N. V. Chichkova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-6962-3260

д.м.н., проф. каф. факультетской терапии №1

Russian Federation, Moscow

L. A. Akulkina

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-4307-8882

ассистент каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

N. M. Bulanov

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-3989-2590

к.м.н., ассистент каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

L. A. Ermolova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-0488-0469

врач-стажер УКБ №3

Russian Federation, Moscow

A. S. Zykova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-7674-8643

к.м.н., науч. сотр., научно-исследовательский отд. здоровьесберегающих технологий

Russian Federation, Moscow

A. A. Kitbalyan

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0003-0546-988X

врач-стажер УКБ №3

Russian Federation, Moscow

A. S. Moiseev

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0003-4390-4467

врач-стажер УКБ №3

Russian Federation, Moscow

P. P. Potapov

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0003-4366-2832

врач-стажер УКБ №3

Russian Federation, Moscow

E. A. Tao

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-0621-7054

науч. сотр. научно-исследовательского отд. здоровьесберегающих технологий

Russian Federation, Moscow

V. I. Sholomova

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-8785-7968

к.м.н., ассистент каф.

Russian Federation, Moscow

A. A. Shchepalina

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0002-1826-0519

врач-стажер УКБ №3

Russian Federation, Moscow

A. A. Yakovleva

Sechenov First Moscow State Medical University (Sechenov University)

Email: avt420034@yahoo.com
ORCID iD: 0000-0001-7295-4821

врач-стажер УКБ №3

Russian Federation, Moscow

References

  1. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020. doi: 10.1001/jama.2020.2648
  2. Henderson LA, Canna SW, Schulert GS, et al. On the alert for cytokine storm: immunopathology in COVID-19. Arthritis Rheumatol. 2020. doi: 10.1002/art.41285
  3. Насонов Е.Л. Коронавирусная болезнь 2019 (COVID-19): размышления ревматолога. Научно-практическая ревматология. 2020;58(2):123-32 [Nasonov EL. Coronavirus disease 2019 (COVID-19): A rheumatologist’s thoughts. Rheumatology Science and Practice. 2020;58(2):123-32 (In Russ.)]. doi: 10.14412/1995-4484-2020-123-132
  4. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4. doi: 10.1016/s0140-6736(20)30628-0
  5. Wang D, Hu B, Hu C, et al. Clinical сharacteristics of 138 hospitalized patients with 2019 novel Coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. doi: 10.1001/jama.2020.1585
  6. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus Disease 2019 pneumonia in Wuhan, China. JAMA Int Med. 2020;58(4):713-4. doi: 10.1016/j.jemermed.2020.04.007
  7. Lazzerini M, Putoto G. COVID-19 in Italy: momentous decisions and many uncertainties. Lancet Glob Health. 2020;8(5):e641-2.
  8. Глыбочко П.В., Фомин В.В., Авдеев С.Н. и др. Клиническая характеристика 1007 больных тяжелой SARS-CoV-2 пневмонией, нуждавшихся в респираторной поддержке. Клин. фармакология и терапия. 2020;29(2):21-9 [Glybochko PV, Fomin VV, Avdeev SN, et al. Clinical characteristics of 1007 intensive care unit patients with SARS-CoV-2 pneumonia. Klinicheskaya farmakologiya i terapiya = Clin Pharmacol Ther. 2020;29(2):21-9 (In Russ.)]. doi: 10.32756/0869-5490-2020-2-21-29
  9. Ren D, Ren R, Yao R-I, et al. Clinical features and development of sepsis in patients infected with SARS-CoV-2: a retrospective analysis of 150 cases outside Wuhan, China. Intensive Care Med. 2020;46:1630-3. doi: 10.1007/s00134-020-06084-5
  10. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. doi: 10.1001/jama.2016.0287
  11. Lin GL, McGinley JP, Drysdale SB, Pollard AJ. Epidemiology and immune pathogenesis of viral sepsis. Front Immunol. 2018;9:2147. doi: 10.3389/fimmu.2018.02147
  12. Li H, Liu L, Zhang D, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses. Lancet. 2020;395(10235):1517-20. doi: 10.1016/S0140-6736(20)30920-X
  13. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62. doi: 10.1016/S0140-6736(20)30566-3
  14. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 Patients. AJR Am J Roentgenol. 2020; p. 1-7. doi: 10.2214/AJR.20.23034
  15. Drucker DJ. Coronavirus infections and type 2 diabetes – shared pathways with therapeutic implications. Endocr Rev. 2020;41(3). pii: bnaa011. doi: 10.1210/endrev/bnaa011
  16. Team CC-R. Preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus Disease 2019 – United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):382-6. doi: 10.15585/mmwr.mm6913e2
  17. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City. BMJ. 2020;369:m1966. doi: 10.1136/bmj.m1966
  18. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis. 2020. pii: ciaa415. doi: 1093/cid/ciaa415
  19. Муромцева Г.А., Концевая А.В., Константинов В.В. и др. Распространенность факторов риска неинфекционных заболеваний в российской популяции в 2012-2013 гг. Результаты исследования ЭССЕ-РФ. Кардиоваскулярная терапия и профилактика. 2014;13(6):4-11 [Muromtseva GA, Kontsevaya AV, Konstantinov VV, et al. The prevalence of non-infectious diseases risk factors in Russian population in 2012-2013 years. Cardiovascular Therapy and Prevention. 2014;13(6):4-11 (In Russ.)].
  20. Pillay TS. Gene of the month: the 2019-nCoV/SARS-CoV-2 novel coronavirus spike protein. J Clin Pathol. 2020. doi: 10.1136/jclinpath-2020-206658
  21. Vaduganathan M, Vardeny O, Michel T, et al. Renin-angiotensin-aldosterone system inhibitors in patients with Covid-19. N Engl J Med. 2020;82:1653-9. doi: 10.1056/nejmc2013707
  22. Moiseev S, Avdeev S, Brovko M, et al. Rheumatic diseases in intensive care unit patients with COVID-19. Ann Rheum Dis. 2020. doi: 10.1136/annrheumdis-2020-217676
  23. Lu C, Li S, Liu Y. Role of immunosuppressive therapy in rheumatic diseases concurrent with covid-19. Ann Rheum Dis. 2020. doi: 10.1136/annrheumdis-2020-217460
  24. Toniati P, Piva S, Cattalini M, et al; Brescia International Research and Training HUB (BIRTH). Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020;19(7):102568. doi: 10.1016/j.autrev.2020.102568
  25. Cantini F, Niccoli L, Matarrese D, et al. Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact. J Infect. 2020;S0163-4453(20)30228-0. doi: 10.1016/j.jinf.2020.04.017
  26. Временные методические рекомендации. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Версия 6 от 28.04.2020. https://static1.rosminzdrav.ru/system/attachments/attaches/000/050/116/original/28042020_%D0%9CR_COVID-19_v6.pdf
  27. Moiseev S, Avdeev S, Brovko M, et al. Is there a future for hydroxychloroquine/chloroquine in prevention of SARS-CoV-2 infection (COVID-19)? Ann Rheum Dis. 2020. pii: annrheumdis-2020-217570. doi: 10.1136/annrheumdis-2020-217570
  28. Geleris J, Sun Y, Platt J, et al. Obesrvational study of hydroxychloroquine in hospitalized patients with COVID-19. NEJM. 2020. doi: 10.1056/ NEJMoa2012410
  29. Moiseev S, Avdeev S, Brovko M, et al. Cancer in intensive care unit patients with COVID-19. J Infection. 2020. doi: 10.1016/j.jinf.2020.05.053
  30. Avdeev S, Moiseev S, Brovko M, et al. Low prevalence of bronchial asthma and chronic obstructive lung disease among intensive care unit patients with COVID-19. Allergy. 2020. doi: 10.1111/all.14420

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Figure: 1. OR, calculated in a logistic regression model for the age of patients as a factor associated with the development of septic shock (reference category - patients under 50 years of age).

Download (108KB)
Indexing metadata
3. Figure: 2. OR, calculated in a logistic regression model for factors associated with the development of septic shock.

Download (282KB)
Indexing metadata
4. Figure: 3. OR, calculated in a logistic regression model for the number of comorbidities as factors associated with the development of septic shock (reference category - patients without comorbidities).

Download (157KB)
Indexing metadata

Copyright (c) 2020 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies