(1442) Association of History of COVID-19 With Short-Term Mortality in Non-COVID Sepsis

Introduction: The risks of sepsis and all-cause mortality are substantially increased among patients with prior history of COVID-19. However, the population-level association of past COVID-19 with short-term mortality in sepsis is unknown.

Methods: We used a statewide dataset to identify hospitalizations aged ≥18 with sepsis in Texas during 2021. Sepsis was defined by "explicit" ICD-10 codes for severe sepsis (R65.20) and septic shock (R65.21). History of COVID-19 was defined by ICD-10 code Z86.16. Hospitalizations with COVID-19 (ICD-10 code U07.1) were excluded. We used a hierarchical, mixed-effects logistic regression model to estimate the association of history of COVID-19 with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations. Sensitivity analyses, using similar approach, were performed on subsets with septic shock, ICU admissions, and those mechanically ventilated.

Results: Among 86,277 sepsis hospitalizations, 2,891 (3.4%) had reported history of COVID-19. Compared to sepsis hospitalizations without past COVID-19, those with prior history of COVID-19 were younger (aged ≥65 years, 54.6% vs 59.3%), with similar frequency of females (50.0% vs 49.6%), more commonly racial/ethnic minority (51.1% vs 48.2%), and had lower mean (SD) Charlson Comorbidity Index (2.4 [2.1] vs 2.6 [2.5]), and number of organ dysfunctions (2.5 [1.5] vs 2.7 [1.6]). Short-term mortality among sepsis hospitalizations with and without past COVID-19 was 27.7% vs 30.9%. On adjusted analysis, history of COVID-19 was not associated with short-term mortality among sepsis hospitalizations overall (adjusted odds ratio [aOR] 1.03 [95% CI 0.93-1.14]) and on sensitivity analyses of hospitalizations with septic shock (aOR 1.00 [95% CI 0.88-1.12]), ICU admission (aOR 1.01 [95% CI 0.90-1.13]), and the mechanically ventilated (aOR 1.11 [95% CI 0.91-1.35]).

Conclusions: In this population-based study, history of COVID-19 was not associated with short-term mortality in non-COVID sepsis. Further studies, exploring the prognostic implications of prior COVID-19 in sepsis across severity strata of COVID-19 episodes and related vaccination status can inform the growing understanding of the long-term sequelae of the pandemic.