Characteristics and Outcomes of Viral Sepsis: A Retrospective Study

BACKGROUND: Although bacteria are frequent causes of sepsis, culture negative sepsis occurs in 11% to 69% of patients, and some may be caused by viruses. The purpose of this study was to determine the characteristics and outcomes of patients with viral sepsis. METHODS: Hospital database study of adult patients with sepsis by Sepsis-3 criteria. In the primary analysis, patients were included if they had cultures or antigen tests positive for virus during the 24 hours before to 24 hours after sepsis onset period and cultures were negative for nonviral organisms. RESULTS: After excluding patients with positive nonviral cultures, 1034 (3.3%) of the remaining 31,109 patients were considered to have viral sepsis. Mortality was 15% at 90 days, compared to 20% for patients with nonviral sepsis. After adjustment, initiation of mechanical ventilation after sepsis onset (odds ratio [OR] = 3.142, 95% confidence interval [CI], 1.692–5.836, P < .001), severity of sepsis as quantified by Sequential Organ Failure Assessment (SOFA) score (OR = 1.159, 95% CI, 1.051–1.278, P = .004) and lactate levels (OR = 1.204, 95% CI, 1.085–1.337; P < .001) were associated with mortality. Receipt of antiviral medications (OR = 1.160, 95% CI, 0.142–9.449, P = .875) was not associated with improved survival. The discrimination of the model was very good (0.845 ± 0.017) and the relevance was good (0.518). CONCLUSIONS: In an adult population meeting Sepsis-3 criteria and negative for other organisms, 3.3% of patients had viral sepsis with 90-day mortality of 15%. Antiviral medicines were not associated with better survival.