Coeliac disease and risk of sepsis

[kickingfrog]

Coeliac disease and risk of sepsis

Posted by Lyn G sunny Dorset on 7/3/2010
GF board
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Gut 2008;57:1074-1080
doi:10.1136/gut.2007.133868



Coeliac disease and risk of sepsis

1. J F Ludvigsson1,2,
2. O Olén3,4,
3. M Bell5,
4. A Ekbom2,
5. S M Montgomery2,6,7


1. Dr Jonas F Ludvigsson, Department of Paediatrics, Örebro University Hospital, Sweden; [e-mail]

* Revised 22 January 2008
* Accepted 2 February 2008
* Published Online First 12 February 2008

Abstract

Objective: To examine the risk of subsequent sepsis in individuals with coeliac disease.

Design: We used Swedish national health registers to identify 15 325 individuals with a diagnosis of coeliac disease (1964–2003) and 14 494 inpatient reference individuals. Cox regression estimated the hazard ratios (HRs) for subsequent sepsis.

Results: Compared with inpatient reference individuals, individuals with coeliac disease were at increased risk of sepsis (HR  = 1.6, 95% confidence interval (95% CI)  = 1.2 to 1.9, p<0.001). The highest risk estimates were seen for pneumococcal sepsis (HR  = 2.5, 95% CI  = 1.2 to 5.1, p = 0.014). Individuals with coeliac disease diagnosed in childhood were not at increased risk of subsequent sepsis (HR  = 1.0, 95% CI  = 0.6 to 1.9, p = 0.908). When individuals with coeliac disease were compared with reference individuals from the general population, coeliac disease was associated with an increased risk of sepsis (HR  = 2.6, 95% CI  = 2.1 to 3.0, p<0.001). The HR for pneumococcal sepsis was 3.9 (95% CI  = 2.2 to 7.0, p<0.001). In this comparison, children with coeliac disease were also at an increased risk of sepsis (HR  = 1.8, 95% CI  = 1.2 to 2.7, p = 0.003).

Conclusion: This study showed a modestly increased risk of sepsis in patients with coeliac disease with the highest risk for pneumococcal sepsis.
This risk increase was limited to those with coeliac disease diagnosed in adulthood.
Potential explanations include hyposplenism, increased mucosal permeability and an altered composition of the intestinal glycocalyx in individuals with coeliac disease.

[kickingfrog]

Coeliac disease and invasive pneumococcal disease: a population-based cohort study

A. RÖCKERT TJERNBERG (a1) (a2), J. BONNEDAHL (a3) (a4), M. INGHAMMAR (a5), A. EGESTEN (a6) ...

doi.org/10.1017/S0950268816003204Published online: 23 January 2017

Summary
Severe infections are recognized complications of coeliac disease (CD). In the present study we aimed to examine whether individuals with CD are at increased risk of invasive pneumococcal disease (IPD).
To do so, we performed a population-based cohort study including 29 012 individuals with biopsy-proven CD identified through biopsy reports from all pathology departments in Sweden. Each individual with CD was matched with up to five controls (n = 144 257). IPD events were identified through regional and national microbiological databases, including the National Surveillance System for Infectious Diseases. We used Cox regression analyses to estimate hazard ratios (HRs) for diagnosed IPD.
A total of 207 individuals had a record of IPD whereas 45/29 012 had CD (0·15%) and 162/144 257 were controls (0·11%).
This corresponded to a 46% increased risk for IPD

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The risk estimate was similar after adjustment for socioeconomic status, educational level and comorbidities, but then failed to attain statistical significance (adjusted HR 1·40, 95% CI 0·99–1·97).

Nonetheless, our study shows a trend towards an increased risk for IPD in CD patients. The findings support results seen in earlier research and taking that into consideration individuals with CD may be considered for pneumococcal vaccination.

www.cambridge.org/core/journals/epidemiology-and-infection/article/coeliac-disease-and-invasive-pneumococcal-disease-a-populationbased-cohort-study/F2E49DDD4B8349E0EC5029E7E36310CC