Study shows link between chronic disease and sepsis risk

Chronic lung and kidney diseases more than double a person’s chance of developing the often-fatal infection.

By Christine S. Moyer — Posted Nov. 9, 2012

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For more than two decades, physicians have tried to combat sepsis by identifying the condition early and treating it aggressively, according to Henry E. Wang, MD, MPH.

But it might be more effective to redirect that focus toward preventing the potentially fatal infection, said Dr. Wang, lead study author and associate professor and vice chair for research in the Dept. of Emergency Medicine at the University of Alabama at Birmingham.

His recommendation is based on new findings that show there is an association between chronic diseases and an increased risk of getting sepsis later. The strongest connection was exhibited in chronic lung disease and chronic kidney disease, according to the study, published online Oct. 31 in PLOS ONE.

Each condition more than doubles a person’s risk of developing sepsis, said the study. Dr. Wang was lead author of the report.

The more chronic diseases a person has, the greater the individual’s risk of getting sepsis, data show.

A possible reason for this association could be chronic inflammation in cells lining the blood vessels, the study said. The mechanisms that cause arteries to become diseased might, over time, make the immune system hypersensitive to viral, bacterial and fungal infections, which could lead to sepsis.

“If public health experts start bringing attention to the risk of future [sepsis] in tandem with messages on major chronic diseases, they may [be] able to even more powerfully motivate lifestyle change” among the public and ultimately prevent sepsis cases, Dr. Wang said.

There are about 750,000 severe sepsis incidents each year in the United States. Up to half of people who develop a severe form of the disease die due to the condition, according to the National Institute of General Medical Sciences.

Researchers examined national data on 30,239 black and white adults age 45 and older who participated in the ongoing Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. They identified participants who were hospitalized for serious infections between Feb. 5, 2003 and Oct. 14, 2011. Researchers assessed clinical and laboratory information from the first 28 hours of a hospital stay and examined health outcomes.

They identified 2,157 hospitalizations for serious infection during the study period, and 1,297 of those hospital stays were due to sepsis. Among the sepsis cases, 975 involved people diagnosed with the condition for the first time.

Researchers compared demographic and clinical characteristics between participants with sepsis and those without the condition. They found that the most common infections associated with first-time sepsis cases were pneumonia, and abdominal, kidney and urinary tract infections (link).

The risk of first-time sepsis was highest among patients who were older, white, current or former smokers, didn’t graduate from high school and made less than $20,000 a year. The likelihood of developing the infection was 79% higher among people with a history of myocardial infarction than it was for individuals who never had the cardiovascular condition.

The risk of sepsis was 78% greater for individuals with diabetes and 67% higher for patients with a history of stroke than for people who didn’t have those conditions.

“It’s sensible for physicians to use this information to motivate general health maintenance” among their patients, Dr. Wang said.

For instance, he said doctors could inform patients that tobacco use and many chronic conditions increase the risk of sepsis, but modifying their health behaviors could prevent chronic diseases.

The study authors said their findings identify associations between chronic medical conditions and sepsis but do not indicate a causal relationship. They say more research is needed to confirm the association and its possible explanations.

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