Association of Septic Shock with Mortality in Hospitalized COVID-19 Patients in Wuhan, China

Shaoqiu Chen; Zitong Gao; Ling Hu; Yi Zuo; Yuanyuan Fu; Meilin Wei; Emory Zitello; Gang Huang; Youping Deng

doi:10.1155/2022/3178283

Association of Septic Shock with Mortality in Hospitalized COVID-19 Patients in Wuhan, China

Adv Virol. 2022 Apr 23:2022:3178283. doi: 10.1155/2022/3178283. eCollection 2022.

Authors

Shaoqiu Chen^{1

2}, Zitong Gao^{1

2}, Ling Hu³, Yi Zuo³, Yuanyuan Fu¹, Meilin Wei⁴, Emory Zitello^{1

2}, Gang Huang⁵, Youping Deng¹

Affiliations

¹ Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA.
² Molecular Biosciences and Bioengineering Program, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI 96822, USA.
³ Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China.
⁴ Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Jiangxi 330006, Nanchang, China.
⁵ Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China.

Abstract

Purpose: Septic shock is a severe complication of COVID-19 patients. We aim to identify risk factors associated with septic shock and mortality among COVID-19 patients.

Methods: A total of 212 COVID-19 confirmed patients in Wuhan were included in this retrospective study. Clinical outcomes were designated as nonseptic shock and septic shock. Log-rank test was conducted to determine any association with clinical progression. A prediction model was established using random forest.

Results: The mortality of septic shock and nonshock patients with COVID-19 was 96.7% (29/30) and 3.8% (7/182). Patients taking hypnotics had a much lower chance to develop septic shock (HR = 0.096, p=0.0014). By univariate logistic regression analysis, 40 risk factors were significantly associated with septic shock. Based on multiple regression analysis, eight risk factors were shown to be independent risk factors and these factors were then selected to build a model to predict septic shock with AUC = 0.956. These eight factors included disease severity (HR = 15, p < 0.001), age > 65 years (HR = 2.6, p=0.012), temperature > 39.1°C (HR = 2.9, p=0.047), white blood cell count > 10 × 10⁹ (HR = 6.9, p < 0.001), neutrophil count > 75 × 10⁹ (HR = 2.4, p=0.022), creatine kinase > 5 U/L (HR = 1.8, p=0.042), glucose > 6.1 mmol/L (HR = 7, p < 0.001), and lactate > 2 mmol/L (HR = 22, p < 0.001).

Conclusions: We found 40 risk factors were significantly associated with septic shock. The model contained eight independent factors that can accurately predict septic shock. The administration of hypnotics could potentially reduce the incidence of septic shock in COVID-19 patients.