Clinical Scorecard: Effects of the COVID-19 Pandemic on the Relationship Between Sepsis Causes and Mortality Rates in ICU Patients in France

At a Glance

Key Highlights

• 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 host immune response to SARS-CoV-2.

• Before the pandemic, viral sepsis was associated with lower in-hospital and 90-day mortality than presumed bacterial sepsis; during the pandemic, viral sepsis mortality risk increased to levels similar to or higher than bacterial sepsis.

• Among co-infected patients, viral sepsis mortality risk increased during the pandemic; in 2022, viral sepsis was associated with higher in-hospital and 90-day mortality than bacterial sepsis.

• 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.

Guideline-Based Recommendations

Diagnosis

• The study identified sepsis-related hospitalizations using explicit and implicit sepsis criteria based on ICD-10 codes. For implicit sepsis, at least 1 code for organ dysfunction or support and ICU admission was additionally required.

• Although this study did not evaluate a clinical guideline, the authors emphasized the need for specific viral sepsis ICD codes to improve identification and management of viral sepsis during future pandemics.

Management

• The study did not test specific management strategies. The authors concluded that the findings support heightened vigilance and targeted management of co-infected sepsis during future pandemics.

• The authors noted that co-infections can markedly alter outcomes in patients with COVID-19 and that superinfections have been documented to worsen outcomes in patients with sepsis and severe viral infections.

Monitoring & Follow-up

• The study assessed in-hospital mortality and mortality within 90 days of admission.

• Across the full study population, 29.2% of patients died during hospitalization and 34.0% died within 90 days of admission.

Risks

• Among co-infected patients, viral sepsis mortality risk increased during the pandemic; 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).

• 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.

Patient & Prescribing Data

The analysis included 604,517 ICU patients with sepsis in metropolitan France from 2018 through 2022. Of these patients, 176,688 (29.2%) died during hospitalization and 205,283 (34.0%) died within 90 days of admission.

The study did not evaluate specific drug therapies or prescribing practices. The authors also noted that data on antibiotics administered during hospitalization and antimicrobial resistance were unavailable.

Clinical Best Practices

• This study did not establish formal clinical best practices, but the authors emphasized heightened vigilance for viral sepsis, particularly when co-infection is present.

• The authors called for more detailed coding strategies for viral sepsis to improve identification and management during future pandemics.

• The study analyzed mortality separately by co-infection status because the interaction between sepsis etiology and co-infection was statistically significant.

Related Resources & Content

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.