Effects of the COVID-19 Pandemic on Sepsis Causes and Mortality in ICU Patients

Overview

This study assessed how the COVID-19 pandemic changed the association between sepsis etiology and in-hospital and 90-day mortality among ICU patients with sepsis in metropolitan France from 2018 through 2022.

Background

Sepsis is a life-threatening condition caused by a dysregulated host response to infection and remains associated with substantial mortality worldwide. Sepsis-related mortality was estimated to account for approximately 20% of global deaths in 2017 and 31.5% in 2021. Severe COVID-19 can be considered a form of sepsis because it may involve a dysregulated immune response to SARS-CoV-2 resulting in organ dysfunction or failure. Secondary infections in patients with COVID-19 may further increase sepsis risk.

Data Highlights

• The study included 604,517 ICU patients with sepsis.

• Overall, 176,688 patients (29.2%) died during hospitalization and 205,283 (34.0%) died within 90 days of admission.

• During 2020-2021, viral sepsis accounted for approximately 30% of cases among both surviving and deceased patients, compared with less than 5% before the pandemic.

• Among co-infected patients in 2022, viral sepsis was associated with higher in-hospital mortality than bacterial sepsis (adjusted odds ratio [aOR], 1.41; 99% CI, 1.15-1.71) and higher 90-day mortality (aOR, 1.23; 99% CI, 1.01-1.49).

Key Findings

• Before the pandemic, viral sepsis was associated with lower in-hospital and 90-day mortality risk than presumed bacterial sepsis among patients with and without co-infections.

• During the pandemic, mortality risk associated with viral sepsis increased to levels similar to or higher than those associated with bacterial sepsis, particularly among patients with co-infections.

• Among patients without co-infection in 2020-2021, fungal or parasitic sepsis was associated with higher in-hospital and 90-day mortality than bacterial sepsis.

• Septic shock was associated with a 3-fold or greater increase in in-hospital and 90-day mortality risk among patients with and without co-infection.

• Sensitivity analyses restricted to patients with a single sepsis stay produced results largely consistent with the primary analysis.

Clinical Implications

The findings highlight the substantial mortality associated with viral-related sepsis during the COVID-19 pandemic, particularly when co-infection is present. The authors emphasized the need for heightened vigilance, more detailed coding strategies for viral sepsis, and targeted management of co-infected sepsis during future pandemics.

Conclusion

The COVID-19 pandemic modified the relationship between sepsis etiology and mortality. Viral-related sepsis, which was associated with lower mortality than bacterial sepsis before the pandemic, showed mortality risks similar to or higher than bacterial sepsis during the pandemic, particularly among co-infected patients. Findings for 90-day mortality followed a similar but attenuated pattern.

Related Resources & Content

1. Global, Regional, and National Sepsis Incidence and Mortality, 1990-2017: Analysis for the Global Burden of Disease Study — Rudd KE, Johnson SC, Agesa KM, et al; The Lancet; 2020; DOI: 10.1016/S0140-6736(19)32989-7.

2. Global, Regional, and National Sepsis Incidence and Mortality, 1990-2021: A Systematic Analysis — Gray AP, Chung E, Hsu RL, et al; The Lancet Global Health; 2025; DOI: 10.1016/S2214-109X(25)00356-0.

3. Long-Term Characteristics and Outcomes of Septic Critically Ill Patients With and Without COVID-19 — Niebhagen F, Heubner L, Kirsch A, et al; Journal of Critical Care; 2025; DOI: 10.1016/j.jcrc.2024.154942.

4. Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2-Associated Sepsis — Shappell CN, Klompas M, Chan C, et al; JAMA Network Open; 2023; DOI: 10.1001/jamanetworkopen.2023.35728.

5. The Impact of the COVID-19 Pandemic on Non-COVID Induced Sepsis Survival — Unterberg M, Rahmel T, Rump K, et al; BMC Anesthesiology; 2022; DOI: 10.1186/s12871-021-01547-8.

6. The Impact of COVID on Bacterial Sepsis — Dar S, Erickson D, Manca C, et al; European Journal of Clinical Microbiology & Infectious Diseases; 2023; DOI: 10.1007/s10096-023-04655-0.

7. Impacts of the COVID-19 Pandemic on Sepsis Incidence, Etiology and Hospitalization Costs in France: A Retrospective Observational Study — Al Rahmoun M, Sabaté-Elabbadi A, Guillemot D, Brun-Buisson C, Watier L; BMC Infectious Diseases; 2025; DOI: 10.1186/s12879-025-11000-7.

8. COVID-19 Bacteremic Co-Infection Is a Major Risk Factor for Mortality, ICU Admission, and Mechanical Ventilation — Patton MJ, Orihuela CJ, Harrod KS, et al; Critical Care; 2023; DOI: 10.1186/s13054-023-04312-0.

9. Fungal and Bacterial Coinfections Increase Mortality of Severely Ill COVID-19 Patients — Silva DL, Lima CM, Magalhães VCR, et al; Journal of Hospital Infection; 2021; DOI: 10.1016/j.jhin.2021.04.001.