Coeliac disease and risk of sepsis
- 1Department of Paediatrics, Örebro University Hospital, Sweden
- 2Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Sweden
- 3Department of Clinical Science and Education, Karolinska Institute, Sweden
- 4Sachs’ Children’s Hospital, Stockholm South General Hospital, Sweden
- 5Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Sweden
- 6Clinical Research Centre, Örebro University Hospital, Sweden
- 7Department of Primary Care and Social Medicine, Charing Cross Hospital, Imperial College, London, UK
- Dr Jonas F Ludvigsson, Department of Paediatrics, Örebro University Hospital, Sweden;
- Revised 22 January 2008
- Accepted 2 February 2008
- Published Online First 12 February 2008
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.
Funding: JFL was supported by a grant from the Örebro University Hospital while writing this article. OO was supported by a grant from the Stockholm South General Hospital and the Department of Clinical Science and Education, Karolinska Institute while contributing to this article. This project was supported by a grant from The Swedish Society of Medicine, the Swedish Research Council, the Sven Jerring Foundation, the Örebro Society of Medicine, the Karolinska Institutet, the Clas Groschinsky Foundation, the Juhlin Foundation, the Majblomman Foundation, Örebro University Hospital, the Swedish Coeliac Society and the Mjölkdroppen Fund.
Competing interests: None.
Ethics approval: This project (04-030/1) was approved by the Research Ethics Committee of the Karolinska Institute, Stockholm, Sweden on the 18 March 2004.