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Respiratory tract viral infections associated sepsis in patients with underlying liver disease: Viral sepsis an entity to look forward!

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Abstract

Background

Sepsis remains a global health burden associated with significant morbidity and mortality. Bacteria are known to be the predominant pathogens in sepsis; however, viral etiologies in sepsis are still under diagnosed. Respiratory viral pathogens have been previously linked to sepsis, but the knowledge of incidence, disease burden and mortality of viral-induced sepsis remains limited. This study aimed at understanding the role of respiratory viral infections in the causation of sepsis in liver disease patients.

Methods

In this retrospective study, the clinical records of liver disease patients with influenza-like illness, whose requests for respiratory viral testing were received from January 2019 to December 2022, were reviewed. Respiratory viruses were identified using FilmArray 2.0 respiratory panel (BioFire Diagnostics, Utah, USA).

Results

Of 1391 patients tested, a respiratory viral etiology was detected in 23%. The occurrence of sepsis was seen in 35%. Among these, isolated viral etiology with no other bacterial/fungal coinfection was found in 55% of patients. Rhinovirus/Enterovirus was found as the most common underlying viral etiology (23.4%). The sepsis prevalence was higher among patients with associated comorbidities (45%) and decompensated cirrhosis (84%). On multi-variable analysis, no factor was found independently associated with sepsis-related mortality.

Conclusion

This study underlines the importance of isolated viral etiology in causation of sepsis among liver disease patients. Patients with comorbidities, older age and decompensated cirrhosis are at an increased risk of developing sepsis and are associated with poorer outcomes. Accurate and timely identification of the viral etiology in sepsis would prevent the misuse of antibiotics and improve overall patient care.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Clinical Virology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110 070, India

    Ekta Gupta, Jasmine Samal, Malika Grover, Nitiksha Rani & Reshu Agarwal

  2. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India

    Rakhi Maiwall & Harshvardhan Tevethia

  3. Department of Epidemiology and Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India

    Tushar Prabhakar & Manya Prasad

  4. Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India

    Arvind Tomar

  5. Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India

    Pratibha Kale & Vikas Khillan

  6. Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India

    Seema Alam

Authors
  1. Ekta Gupta
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  2. Jasmine Samal
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Contributions

EG: Conceptualization, final manuscript editing, supervision and project administration, JS: Manuscript writing and study design; RM and HT: Manuscript editing and clinical data evaluation, MG: manuscript editing, NR: Data compilation, TP: Statistical analysis, MP: Data analysis and manuscript editing, AT: Clinical data evaluation, RA: Data interpretation and manuscript editing and PK, VK and SA: Clinical data evaluation.

Corresponding author

Correspondence to Ekta Gupta.

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Conflict of interest

EG, JS, RM, HT, MG, NR, TP, MP, AT, RA, PK, VK and SA declare that they have no conflict of interest pertaining to this article.

Institutional review board

The Institutional Review Board (Institutional Ethics Committee, ILBS) reviewed and approved the study (Ethical Approval Number—IEC/2021/84/MA10). The study was conducted as per the policy of the Declaration of Helsinki. The Institutional Review Board (Institutional Ethics Committee, ILBS) waived informed consent because the study was based on the retrospective analysis of existing clinical data. Patient records or information were anonymized and de-identified before analysis.

Informed consent

This was a retrospective study, so patient informed consent was waived.

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The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Gupta, E., Samal, J., Maiwall, R. et al. Respiratory tract viral infections associated sepsis in patients with underlying liver disease: Viral sepsis an entity to look forward!. Indian J Gastroenterol (2024). https://doi.org/10.1007/s12664-024-01536-y

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