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Coeliac disease and risk of sepsis
  1. Jonas F Ludvigsson (jonasludvigsson{at}yahoo.com)
  1. Orebro University Hospital, Sweden
    1. Ola Olén (ola.olen{at}sodersjukhuset.se)
    1. Sachs’ Children’s Hospital, Stockholm South General Hospital, Sweden
      1. Max Bell (max.bell{at}karolinska.se)
      1. Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Sweden
        1. Anders Ekbom (anders.ekbom{at}ki.se)
        1. Clinical Epidemiology Unit, Dept of Medicine, Karolinska Univ; and Harvard Medical School, Boston, Sweden
          1. Scott M Montgomery (scott.montgomery{at}ki.se)
          1. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Sweden

            Abstract

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

            Design: We used Swedish national health registers to identify 15,325 individuals with a diagnosis of CD (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 CD were at increased risk of sepsis (Hazard ratio (HR) = 1.6; 95% CI = 1.2-1.9; p < 0.001). The highest risk estimates were seen for pneumococcal sepsis (HR = 2.5; 95% CI = 1.2-5.1; p = 0.014). Individuals with CD diagnosed in childhood were not at increased risk of subsequent sepsis (HR = 1.0; 95% CI = 0.6-1.9; p = 0.908). When individuals with CD were compared with reference individuals from the general population, CD was associated with an increased risk of sepsis (HR = 2.6; 95% CI = 2.1-3.0; p <0.001). The HR for pneumococcal sepsis was 3.9 (95% CI = 2.2-7.0; p < 0.001). In this comparison, children with CD were also at an increased risk of sepsis (HR = 1.8; 95% CI = 1.2-2.7; p = 0.003).

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

            • Pneumococci
            • autoimmunity
            • coeliac
            • cohort
            • sepsis

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