Ang SP, Chia JE, Lorenzo-Capps MJ, Lee E, Iglesias J. Racial and ethnic differences in COVID-19-associated septic shock. World J Crit Care Med 2025; 14(3): 108296 [DOI: 10.5492/wjccm.v14.i3.108296]
Corresponding Author of This Article
Jose Iglesias, Associate Professor, Doctor, DO, FASN, Department of Internal Medicine, Hackensack Meridian School of Medicine, 123 Metro Blvd, Nutley, NJ 07110, United States. jiglesias23@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Sep 9, 2025; 14(3): 108296 Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.108296
Racial and ethnic differences in COVID-19-associated septic shock
Song-Peng Ang, Jia-Ee Chia, Maria Jose Lorenzo-Capps, Eunseuk Lee, Jose Iglesias
Song-Peng Ang, Maria Jose Lorenzo-Capps, Eunseuk Lee, Jose Iglesias, Department of Internal Medicine, Rutgers Health Community Medical Center, Toms River, NJ 08755, United States
Jia-Ee Chia, Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79912, United States
Jose Iglesias, Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
Co-first authors: Song-Peng Ang and Jia-Ee Chia.
Author contributions: Ang SP performed data analysis; Ang SP and Iglesias J conceptualized and designed the study; Chia JE performed data curation; Iglesias J supervised the study; Ang SP, Chia JE, Lorenzo-Capps MJ, Lee E and Iglesias J were involved in writing and reviewing the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study involved analysis of publicly available database with de-identified data. Hence, ethical approval was waived by the Rutgers Health Community Medical Center Institutional Review Board.
Informed consent statement: The National Inpatient Sample database did not provide patient identifiers and strictly adhered to the HIPAA Privacy Rule. Given the use of deidentified data, informed consent was not required.
Conflict-of-interest statement: All authors have no conflict of interest to declare.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data supporting this study are extracted from the National Inpatient Sample and are available upon application to the Healthcare Cost and Utilization Project database. Restrictions applied as these were used under license for this study.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jose Iglesias, Associate Professor, Doctor, DO, FASN, Department of Internal Medicine, Hackensack Meridian School of Medicine, 123 Metro Blvd, Nutley, NJ 07110, United States. jiglesias23@gmail.com
Received: April 13, 2025 Revised: May 8, 2025 Accepted: June 4, 2025 Published online: September 9, 2025 Processing time: 98 Days and 15.4 Hours
Abstract
BACKGROUND
Septic shock, the most severe form of sepsis, remains a major global health challenge with high mortality. The coronavirus disease 2019 (COVID-19) pandemic has exacerbated this burden, as severe acute respiratory syndrome coronavirus 2 infection often leads to sepsis and septic shock. Racial and ethnic differences in critical illness outcomes are well-documented, but their impact on COVID-19 associated septic shock remains unclear.
AIM
To examine epidemiologic data to explore racial and ethnic differences in outcomes in COVID-19 associated septic shock.
METHODS
Using the National Inpatient Sample (2020–2021), we conducted a retrospective cohort study to assess racial and ethnic disparities in septic shock outcomes among adults (≥ 18 years) with concurrent COVID-19. Primary and secondary outcomes included in-hospital mortality, acute kidney injury (AKI), AKI requiring dialysis, and mechanical ventilation. Adjusted multivariable logistic regression accounted for demographics, comorbidities, hospital characteristics, and in-hospital events.
RESULTS
Among 396795 weighted hospitalizations, Non-Hispanic Black (NHB) (25.3%) and Hispanic (30.4%) populations were younger and had greater comorbidity burdens than Non-Hispanic White (NHW) patients. Compared to NHW, adjusted analyses showed higher in-hospital mortality [adjusted odds ratio (aOR) = 1.21, 95%CI: 1.15–1.27], mechanical ventilation use (aOR = 1.19, 95%CI: 1.12–1.27) and AKI requiring dialysis (aOR = 1.16, 95%CI: 1.07-1.25, P < 0.001) among Hispanic patients. NHB patients had similar mortality to NHWs but had higher risk of mechanical ventilation (aOR = 1.15, 95%CI: 1.09–1.22) and AKI requiring dialysis (aOR = 1.65, 95%CI: 1.54–1.76). Mean length of stay and cost were longest and highest for Hispanic patients.
CONCLUSION
Our study showed that there was higher mortality in Hispanic patients, and higher renal and respiratory complication in both NHB and Hispanic groups compared to NHW group. Future research identifying the causes of the observed differences in complications are required to inform targeted strategies that may mitigate modifiable risk factors and optimize early detection of organ failure to optimize outcomes in this population.
Core Tip: Our study highlights significant racial and ethnic differences in outcomes among patients with coronavirus disease 2019-associated septic shock, with Hispanic patients experiencing higher in-hospital mortality and Non-Hispanic Black patients facing increased risks of severe complications like acute kidney injury requiring dialysis and mechanical ventilation. These disparities are influenced by multifactorial determinants, including socioeconomic status, comorbidity burden, and hospital-level factors, emphasizing the need to address healthcare inequities and improve outcomes for minority populations.
