(1604) Impact of COVID-19 on Short-Term Mortality in Non-COVID-19 Candidal Sepsis

Introduction: Candidemia is associated with persistently high mortality. The COVID-19 pandemic has been associated with increased short-term mortality in non-COVID-19 sepsis, but evidence on its impact on non-COVID-19 candidal sepsis is scarce. We examined the population-level impact of the pandemic on short-term mortality in patients with non-COVID-19 candidal sepsis.

Methods: We used a statewide dataset to identify hospitalizations aged ≥18 years with candidal sepsis in Texas during 2016-2022. Candidal sepsis was defined by ICD-10 code B377. COVID-19 admissions (ICD-10 code U071) were excluded. Interrupted time series analyses (ITSA), employing segmented hierarchical logistic models was used to estimate pre-pandemic (1/1/2016-3/31/2020) trends, level (intercept) change, pandemic (4/1/2020-12/31/2022) trend, and change of trends in short-term mortality (defined as in-hospital death or discharge to hospice) in candidal sepsis, expressed as average marginal effects (AME). AME indicate the absolute change in probability of mortality. Sensitivity analyses were conducted on ICU admissions, those with septic shock, mechanical ventilation, and aged ≥65 years.

Results: There were 6,367 hospitalizations with candidal sepsis during the study period (74.3% aged ≥65 years, 62.7% female, mean [SD] Charlson Comorbidity Index 2.9 [2.7], and mean [SD] number of organ dysfunctions 2.4 [1.7]). Short-term mortality was 26.1% overall. On ITSA, short-term mortality did not change during the prepandemic period (AME -0.12%/quarter [95% CI -0.34 to 0.10]), and there was no level change (AME 1.54% [95% CI -1.74 to 4.83]) or change in trends (AME 0.36% [95% CI -0.08 to 0.80]). Findings on sensitivity analyses were consistent with those of the primary model, except among those admitted to ICU, where short-term mortality rose during the pandemic period (AME 0.52%/quarter [95% CI 0.03 to 1.01]), with change of trends between the prepandemic and pandemic periods (AME 0.62% [95% CI 0.06 to 1.19]).

Conclusions: Short-term mortality among hospitalizations with non-COVID-19 candidal sepsis was persistently high but was not affected by the COVID-19 pandemic overall. However, short-term mortality rose progressively during the pandemic among the subset admitted to ICU.