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Published on: December 15, 2011
Coeliac disease and risk of sepsis
J F Ludvigsson1, O Olén, M Bell
1Department of Paediatrics, Orebro University Hospital, Sweden. jonasludvigsson@yahoo.com
Insights
Individuals with coeliac disease face a modestly increased risk of sepsis, particularly pneumococcal sepsis. This heightened risk is primarily observed in adults diagnosed with coeliac disease.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Coeliac disease is an autoimmune disorder affecting the small intestine.
- Previous research suggests potential links between coeliac disease and increased infection risk.
Purpose of the Study:
- To investigate the risk of developing sepsis in individuals diagnosed with coeliac disease.
- To identify specific types of sepsis and patient demographics associated with increased risk.
Main Methods:
- Utilized Swedish national health registers for a cohort study (1964-2003).
- Identified 15,325 individuals with coeliac disease and 14,494 inpatient reference individuals.
- Employed Cox regression to calculate hazard ratios (HRs) for subsequent sepsis.
Main Results:
- Coeliac disease patients showed a 1.6-fold increased risk of sepsis compared to inpatient controls (HR=1.6, 95% CI=1.2-1.9).
- The risk was highest for pneumococcal sepsis (HR=2.5, 95% CI=1.2-5.1).
- Adult-diagnosed coeliac disease patients had a 2.6-fold increased risk of sepsis versus general population controls (HR=2.6, 95% CI=2.1-3.0), with pneumococcal sepsis risk at 3.9 (HR=3.9, 95% CI=2.2-7.0).
Conclusions:
- Coeliac disease is associated with a modest increase in sepsis risk, predominantly pneumococcal sepsis.
- This increased risk is confined to individuals diagnosed with coeliac disease in adulthood.
- Potential contributing factors include hyposplenism, increased intestinal permeability, and altered intestinal glycocalyx composition.
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.
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