Introduction: The COVID-19 pandemic has been associated with increased short-term mortality in non-COVID-19 sepsis, compared to the prepandemic period, which remained unchanged during the latter years of the pandemic in a recent multicenter study. However, the mortality trajectories among patients with non-COVID-19 septic shock remain unknown. We have examined the population-level temporal trends in short-term mortality of non-COVID-19 septic shock patients during the COVID-19 pandemic. Methods: We used a statewide dataset to identify hospitalizations aged ≥18 years with a diagnosis of septic shock in acute care hospitals in Texas from April 1, 2020 to December 31, 2023. Admissions with COVID-19 (defined as ICD-10 code U07.1) were excluded. Septic shock was defined as ICD-10 code R65.21. Hierarchical logistic models were fit to estimate the association of time (quarters) with short-term mortality (defined as in-hospital death or discharge to hospice) among non-COVID-19 hospitalizations with septic shock overall and on sensitivity analyses of those aged ≥65 years and the mechanically ventilated. Models were expressed as average marginal effects (AME), indicating change in absolute probability of death. Results: Among 203,052 non-COVID-19 hospitalizations with septic shock, 117,246 (57.7%) were aged ≥65 years, 90,122 (49.5%) were female, 99,435 (49.0%) were racial and ethnic minority, with mean (SD) Charlson Comorbidity Index 2.9 (2.6) and mean (SD) number of organ dysfunctions 2.9 (2.6); 53,855 (26.5%) were mechanically ventilated. Overall short-term mortality was 41.1%. On adjusted analyses, short-term mortality decreased over time among septic shock hospitalizations (AME -0.07%/quarter 95% CI -0.11 to -0.03; p < 0.001) overall and among those aged ≥65 years (AME -0.12%/quarter 95% CI -0.17 to -0.06, p < 0.001), but not among those requiring mechanical ventilation (AME -0.01%/quarter 95% CI -0.09 to 0.07; p = 0.827). Conclusions: During the COVID-19 pandemic, short-term mortality decreased among patients with non-COVID-19 septic shock overall and among older adults. However, no mortality improvement was observed among patients with septic shock requiring mechanical ventilation. Further studies are needed to determine the factors underlying the contrast between our findings and prior reports.
Khair et al. (Sun,) studied this question.