Impact of medical history of severe COVID-19 infection on serum cytokine levels and prognosis in patients with sepsis: A prospective observational study

Abstract

A history of severe COVID-19 may have lasting effects on immune and coagulation dysfunction, potentially influencing sepsis outcomes. This study investigates the impact of severe COVID-19 history on inflammatory markers, coagulation parameters, and prognosis in sepsis patients. This prospective observational study included 181 sepsis patients, comprising 28 with a history of severe COVID-19 infection and 153 without such a history, admitted between October 2021 and May 2023. Serum C-reactive protein (CRP), Interleukin (IL)-6, IL-1β, IL-17, and Tumor necrosis factor-α were measured by enzyme-linked immunosorbent assay (ELISA). Coagulation markers activated partial thromboplastin time (APTT), prothrombin time (PT) and D-dimer (D-D), inflammatory factor procalcitonin (PCT), and severity scores sequential organ failure assessment and acute physiology and chronic health evaluation II were assessed. Kaplan-Meier survival analysis and multivariate logistic regression were used to evaluate 28-day mortality and associated risk factors. Patients with severe COVID-19 history showed significantly higher sequential organ failure assessment and acute physiology and chronic health evaluation II scores, along with elevated APTT, PCT, IL-6, IL-1β, and IL-17 levels. CRP and tumor necrosis factor-α levels did not differ significantly. Among patients with poor prognosis, IL-6, IL-17, and APTT levels were higher, and a larger proportion had a history of severe COVID-19 (36.8% vs 5.6%). Kaplan-Meier analysis showed reduced 28-day survival in the severe COVID-19 group. Multivariate analysis identified BMI, sex, diabetes, severe COVID-19 history, PCT, D-D, and IL-17 as independent risk factors for poor outcomes. Sepsis patients with a history of severe COVID-19 exhibit more severe disease, immune dysregulation, coagulation abnormalities, and increased mortality, indicating long-term detrimental effects of prior infection on sepsis prognosis.