JMIR Publications

ABSTRACT

Background:

Viral infections, including those leading to sepsis, are common but often overlooked in clinical practice, yet the treatment strategies for viral sepsis remain inadequately defined.

Methods:

This retrospective cohort study was conducted across public hospitals in Hong Kong. We included patients diagnosed with COVID-19 between February 22, 2022, and June 30, 2023, who had no secondary bacterial or fungal infections. Propensity score matching was employed to assess the efficacy of the antivirals nirmatrelvir-ritonavir and molnupiravir across various presentations of organ dysfunction at hospital admission, such as circulatory shock, respiratory failure, acute kidney injury, coagulopathy, acute liver impairment, a composite of all organ dysfunctions, or absent organ dysfunction. Key outcomes were in-hospital mortality and length of stay, reported as hazard ratios (HR) and mean differences. Findings: The study included 15,599 COVID-19 patients with a mean age of 75.1 years (SD:15.9). Antiviral treatment was associated with a significantly lower risk of mortality in patients without organ dysfunction for both nirmatrelvir-ritonavir (HR:0.17 [95% CI:0.05 to 0.56]) and molnupiravir (HR:0.29 [95% CI:0.15 to 0.56]). However, no mortality benefit was observed with antiviral use in patients with any form of organ dysfunction. Antivirals however reduced the length of hospital stay, with reductions ranging from a minimum of 3.4 days to a maximum of 7.25 days, depending on the type of organ dysfunction. Interpretation: While antivirals did not reduce mortality in patients with viral sepsis, they were effective in decreasing the length of hospital stay.