Racial and ethnic differences in COVID-19-associated septic shock

Abstract

BACKGROUND

Septic shock, the most severe form of sepsis, remains a major global health challenge with high mortality. The coronavirus disease 2019 (COVID-19) pandemic has exacerbated this burden, as severe acute respiratory syndrome coronavirus 2 infection often leads to sepsis and septic shock. Racial and ethnic differences in critical illness outcomes are well-documented, but their impact on COVID-19 associated septic shock remains unclear.

AIM

To examine epidemiologic data to explore racial and ethnic differences in outcomes in COVID-19 associated septic shock.

METHODS

Using the National Inpatient Sample (2020–2021), we conducted a retrospective cohort study to assess racial and ethnic disparities in septic shock outcomes among adults (≥ 18 years) with concurrent COVID-19. Primary and secondary outcomes included in-hospital mortality, acute kidney injury (AKI), AKI requiring dialysis, and mechanical ventilation. Adjusted multivariable logistic regression accounted for demographics, comorbidities, hospital characteristics, and in-hospital events.

RESULTS

Among 396795 weighted hospitalizations, Non-Hispanic Black (NHB) (25.3%) and Hispanic (30.4%) populations were younger and had greater comorbidity burdens than Non-Hispanic White (NHW) patients. Compared to NHW, adjusted analyses showed higher in-hospital mortality [adjusted odds ratio (aOR) = 1.21, 95%CI: 1.15–1.27], mechanical ventilation use (aOR = 1.19, 95%CI: 1.12–1.27) and AKI requiring dialysis (aOR = 1.16, 95%CI: 1.07-1.25, P < 0.001) among Hispanic patients. NHB patients had similar mortality to NHWs but had higher risk of mechanical ventilation (aOR = 1.15, 95%CI: 1.09–1.22) and AKI requiring dialysis (aOR = 1.65, 95%CI: 1.54–1.76). Mean length of stay and cost were longest and highest for Hispanic patients.

CONCLUSION

Our study showed that there was higher mortality in Hispanic patients, and higher renal and respiratory complication in both NHB and Hispanic groups compared to NHW group. Future research identifying the causes of the observed differences in complications are required to inform targeted strategies that may mitigate modifiable risk factors and optimize early detection of organ failure to optimize outcomes in this population.

Keywords: COVID-19; Sociodemographic; Race; Ethnicity; Mortality; Septic shock; Critical care; Outcome

Core Tip: Our study highlights significant racial and ethnic differences in outcomes among patients with coronavirus disease 2019-associated septic shock, with Hispanic patients experiencing higher in-hospital mortality and Non-Hispanic Black patients facing increased risks of severe complications like acute kidney injury requiring dialysis and mechanical ventilation. These disparities are influenced by multifactorial determinants, including socioeconomic status, comorbidity burden, and hospital-level factors, emphasizing the need to address healthcare inequities and improve outcomes for minority populations.