The impact of the COVID-19 pandemic on non-COVID induced sepsis survival
Authors: Unterberg Matthias , Rahmel Tim , Rump Katharina , Wolf Alexander , Haberl Helge , von Busch Alexander , Bergmann Lars , Bracht Thilo , Zarbock Alexander , Ehrentraut Stefan Felix , Putensen Christian , Wappler Frank , Köhler Thomas , Ellger Björn , Babel Nina , Frey Ulrich , Eisenacher Martin , Kleefisch Daniel , Marcus Katrin , Sitek Barbara , Adamzik Michael , Koos Björn , Nowak Hartmuth ,   on behalf of the SepsisDataNet.NRW research group, Adamzik Michael , Anft Moritz , Annecke Thorsten , Babel Nina , Bazzi Maha , Bergmann Lars , Bode Christian , Bracht Thilo , von Busch Alexander , Defosse Jerome M. , Ehrentraut Stefan F. , Eisennacher Martin , Ellger Björn , Ertmer Christian , Frey Ulrich H. , Fuchs Katrin , Haberl Helge , Henzler Dietrich , Kleefisch Daniel , Köhler Thomas , Koos Björn , Limper Ulrich , Marcus Katrin , Nowak Hartmuth , Oswald Daniel , Putensen Christian , Rahmel Tim , Rump Katharina , Schewe Jens-Christian , Schwier Elke , Sitek Barbara , Unterberg Matthias , Wappler Frank , Willemsen Katrin , Wolf Alexander , Zarbock Alexander , Zuelch Birgit 
Published: January 2022

Abstract
Background
The COVID-19 pandemic has taken a toll on health care systems worldwide, which has led to increased mortality of different diseases like myocardial infarction. This is most likely due to three factors. First, an increased workload per nurse ratio, a factor associated with mortality. Second, patients presenting with COVID-19-like symptoms are isolated, which also decreases survival in cases of emergency. And third, patients hesitate to see a doctor or present themselves at a hospital. To assess if this is also true for sepsis patients, we asked whether non-COVID-19 sepsis patients had an increased 30-day mortality during the COVID-19 pandemic.

Methods
This is a post hoc analysis of the SepsisDataNet.NRW study, a multicentric, prospective study that includes septic patients fulfilling the SEPSIS-3 criteria. Within this study, we compared the 30-day mortality and disease severity of patients recruited pre-pandemic (recruited from March 2018 until February 2020) with non-COVID-19 septic patients recruited during the pandemic (recruited from March 2020 till December 2020).

Results
Comparing septic patients recruited before the pandemic to those recruited during the pandemic, we found an increased raw 30-day mortality in sepsis-patients recruited during the pandemic (33% vs. 52%, p = 0.004). We also found a significant difference in the severity of disease at recruitment (SOFA score pre-pandemic: 8 (5 - 11) vs. pandemic: 10 (8 - 13); p < 0.001). When adjusted for this, the 30-day mortality rates were not significantly different between the two groups (52% vs. 52% pre-pandemic and pandemic, p = 0.798).

Conclusions
This led us to believe that the higher mortality of non-COVID19 sepsis patients during the pandemic might be attributed to a more severe septic disease at the time of recruitment. We note that patients may experience a delayed admission, as indicated by elevated SOFA scores. This could explain the higher mortality during the pandemic and we found no evidence for a diminished quality of care for critically ill sepsis patients in German intensive care units.