Deaths from acute respiratory distress syndrome (ARDS) and sepsis spiked in the US during the COVID pandemic, and subsequently declined, according to new data presented at the American College of Chest Physicians (CHEST) 2025 Annual Meeting.

Sepsis is a leading cause of ARDS, and patients whose ARDS was caused by sepsis have higher fatality rates than those with other ARDS risk factors, lead author Wajeeh Hassan, MD, of Allama Iqbal Medical College, Lahore, Pakistan, and colleagues wrote in their poster.

Timely treatment of patients with sepsis and ARDS is essential to reducing the need for mechanical ventilation, but data to help identify high-risk populations are limited, the researchers noted.

“We wanted to see how many sepsis patients died from ARDS, and the impact of COVID-19,” said co-author Rohab Sohail, MD, internal medicine resident at the Bayhealth Medical Center, Dover, Delaware, who presented the study at the meeting.

The researchers also sought to examine ARDS and sepsis rates post-COVID to determine whether there is a new baseline, Sohail said.

The researchers reviewed US mortality trends in patients with coexisting ARDS and sepsis from 1999 to 2023, using death certificates from the CDC and CDC’s WONDER online database. The study population included adults aged 25 years or older with sepsis and ARDS based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes.

A total of 86,761 deaths from both ARDS and sepsis occurred during the study period. The age-adjusted mortality rate (AAMR) for individuals with both conditions decreased from 1.9 to 1.2 between 1999 and 2019. During the COVID pandemic period, the AAMR spiked to 2.8 and 3.9 in 2020 and 2021, respectively, a 44.2% increase from pre-pandemic levels. This increase was followed by a rapid 45.1% decrease to 1.3 in 2023. The mortality trend declined from 1999 to 2006, remained stable until 2018, peaked between 2018 and 2021, and declined again until 2023.

Overall, men had slightly higher AAMRs than women (1.8 vs 1.4), although both sexes showed a net annual 2.0% decrease until 2023.

The COVID-era increase in AAMR was highest in non-Hispanic Asian individuals (66.1%), followed by Hispanics (61.0%), non-Hispanic Blacks (41.0%), non-Hispanic American Indians (40.8%), and non-Hispanic Whites (34.8%), although post-COVID rates decreased across all racial groups.

Urban areas experienced greater COVID-era increases in AAMR than rural areas (47.4% vs 36.1%), with the highest increase occurring in the District of Columbia, Rhode Island, Alabama, West Virginia, and South Carolina. However, by region, the western US had the highest COVID-era increase in AAMR from ARDS/sepsis (53.0%) compared to the South and Midwest (49.6% and 38.8%, respectively). The AAMR in the northeast increased during the COVID pandemic period, but difference was not significant compared to the pre-COVID period.

“We were surprised to see that the post-COVID baseline is same as pre-COVID, reenforcing the fact that COVID at present is equivalent to common cold in its impact on patient outcomes, due in part to vaccination and advances in management,” Sohail told Medscape Medical News.

The study design did not allow for quantifying patients by comorbidities, Sohail noted. However, the overall results revealed the increased vulnerability of adults with both ARDS and sepsis during the COVID pandemic, the researchers noted.

The post-pandemic decline in mortality from these conditions emphasizes the urgent need to bolster pandemic preparedness, implement targeted interventions, improve healthcare access, and optimize sepsis management to reduce mortality disparities, the researchers concluded.

Outcomes Vary With Access, Exclusive of COVID

“Sepsis and ARDS are common comorbidities, with sepsis frequently being the trigger for development of ARDS,” David R. Manoff, MD, chief of pulmonary and critical care medicine at the Temple University Hospital-Jeanes Campus and associate professor of clinical thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, both in Philadelphia, told Medscape Medical News. As clinicians look to further characterize different populations of patients with ARDS, the current study adds to the knowledge stratification regarding mortality with the combination of sepsis and ARDS both with and without COVID, said Manoff.

Both sepsis and ARDS have high levels of morbidity and mortality individually, so the findings were not unexpected, Manoff told Medscape Medical News. The current study also underscores the geographic and demographic heterogeneity of outcomes in sepsis with consequent ARDS, he said. “Put simply, those who are less likely to be able to readily access critical care are more likely to die from these conditions,” Manoff said.

As mortality improved over time prior to COVID, standard-of-care treatment strategies for ARDS, including low tidal volume ventilation and prone positioning improved outcomes, Manoff noted. “In the setting of COVID-19, close contacts led to more exposures and with this, more cases and higher mortality. Excluding COVID-19, worse outcomes were seen in those who potentially have less ability to readily access dedicated critical care resources,” he said.

The current study does well in examining the correlation in demographic trends with the combination of sepsis and ARDS, said Manoff. “However, the sepsis ICD-10 code used, A41, is generally associated with sepsis billing with less acute patients, rather than R65, which is associated with severe sepsis and septic shock, and it is unclear if using this code would have appreciably changed the distribution of mortality among the demographics researched,” he noted.

The study received no outside funding. The researchers had no financial conflicts to disclose. Manoff had no financial conflicts to disclose.