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Short- and long-term mortality due to sepsis in patients with rheumatoid arthritis

  • Observational Research
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Abstract

Severe infections and sepsis are common among patients with rheumatoid arthritis (RA) and are associated with increased morbidity and mortality risks. To determine whether RA is an independent risk factor for short- and long-term mortality in patients admitted to an Intensive Care Unit (ICU) with sepsis. A retrospective age- and sex-matched cohort study, based on data of the SEPSIS-ISR Registry, an ongoing study that collects data on all patients admitted with the diagnosis of sepsis to the ICUs of 7 large hospitals during the period 2002–2012. The primary outcomes of the study were the 30-day and 3-years survival rates. A total of 124 RA patients and 248 non-RA patients (mean age 71 years; 64.5% female) were included. Primary site of infection as well as pathogens distributions were similar between the two groups. Severe sepsis and septic shock were diagnosed in 92% vs. 84% (p = 0.03) and 50% versus 39% (p = 0.06) of the RA patients and non-RA, respectively. 30-day survival rates were similar between groups, whereas 3-year survival rate in 30-day survivors was significantly lower among RA patients (34.9%) compared to non-RA patients (55.7%) (p = 0.01). In multivariate Cox proportional hazards regression, RA was found to be a significant independent risk factor for 3-year mortality in 30-day survivors (hazard ratio 1.63 95% confidence interval 1.03–1.63; p = 0.04). RA is an independent risk factor for 3-year mortality, but not short-term mortality following ICU admission with sepsis.

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References

  1. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46(9):2287–2293

    Article  PubMed  Google Scholar 

  2. Mutru O, Laakso M, Isomäki H, Koota K (1985) Ten year mortality and causes of death in patients with rheumatoid arthritis. Br Med J (Res Clin Ed) 290:1797–1799

    Article  CAS  Google Scholar 

  3. Mok CC, Kwok CL, Ho LY, Chan PT, Yip SF (2011) Life expectancy, standardized mortality ratios, and causes of death in six rheumatic diseases in Hong Kong, China. Arthritis Rheum 63:1182–1189

    Article  CAS  PubMed  Google Scholar 

  4. Wolfe F, Mitchell DM, Sibley JT et al (1994) The mortality of rheumatoid arthritis. Arthritis Rheum 37(4):481–494

    Article  CAS  PubMed  Google Scholar 

  5. Sihvonen S, Korpela M, Laippala P, Mustonen J, Pasternack A (2004) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study. Scand J Rheumatol 33:221–227

    Article  CAS  PubMed  Google Scholar 

  6. Thomas E, Symmons DPM, Brewster DH, Black RJ, Macfarlane GJ (2003) National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study. J Rheumatol 30:958–965

    PubMed  Google Scholar 

  7. Au K, Reed G, Curtis JR et al (2011) High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis 70:785–791

    Article  PubMed  Google Scholar 

  8. Weaver A, Troum O, Hooper M et al (2013) Rheumatoid arthritis disease activity and disability affect the risk of serious infection events in RADIUS 1. J Rheumatol 40:1275–1281

    Article  PubMed  Google Scholar 

  9. Franklin J, Lunt M, Bunn D, Symmons D, Silman A (2007) Risk and predictors of infection leading to hospitalisation in a large primary-care-derived cohort of patients with inflammatory polyarthritis. Ann Rheum Dis 66:308–312

    Article  PubMed  Google Scholar 

  10. Germano V, Cattaruzza MS, Osborn J et al (2014) Infection risk in rheumatoid arthritis and spondyloarthropathy patients under treatment with DMARDs, corticosteroids and TNF-α antagonists. J Transl Med 12:77

    Article  PubMed  PubMed Central  Google Scholar 

  11. Klareskog L, Stolt P, Lundberg K et al (2006) A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 54:38–46

    Article  CAS  PubMed  Google Scholar 

  12. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Predictors of infection in rheumatoid arthritis. Arthritis Rheum 46(9):2294–2300

    Article  PubMed  Google Scholar 

  13. Listing J, Gerhold K, Zink A (2013) The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology 52:53–61

    Article  CAS  PubMed  Google Scholar 

  14. Strangfeld A, Eveslage M, Schneider M et al (2011) Treatment benefit or survival of the fittest: what drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient? Ann Rheum Dis 70:1914–1920

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Vincent J-L, Sakr Y, Sprung CL et al (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353

    Article  PubMed  Google Scholar 

  16. Dreiher J, Almog Y, Sprung CL et al (2012) Temporal trends in patient characteristics and survival of intensive care admissions with sepsis: a multicenter analysis*. Crit Care Med 40(3):855–860

    Article  PubMed  Google Scholar 

  17. Hodgin KE, Moss M (2008) The epidemiology of sepsis. Curr Pharm Des 14:1833–1839

    Article  CAS  PubMed  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  19. Wang HE, Szychowski JM, Griffin R, Safford MM, Shapiro NI, Howard G (2014) Long-term mortality after community-acquired sepsis: a longitudinal population-based cohort study. BMJ Open 4(1):e004283

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lemay AC, Anzueto A, Restrepo MI, Mortensen EM (2014) Predictors of long-term mortality after severe sepsis in the elderly. Am J Med Sci 347:282–288

    Article  PubMed  PubMed Central  Google Scholar 

  21. Blanco J, Muriel-Bombín A, Sagredo V et al (2008) Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care 12(6):R158

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhou J, Qian C, Zhao M et al (2014) Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS ONE 9(9):e107181

    Article  PubMed  PubMed Central  Google Scholar 

  23. Martin GS, Mannino DM, Eaton S, Moss M, The Epidemiology of Sepsis in the United States from (2003) 1979 Through 2000. N Engl J Med 348:1546–1554

    Article  PubMed  Google Scholar 

  24. Brun-Buisson C, Doyon F, Carlet J et al (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 274(12):968–974

    Article  CAS  PubMed  Google Scholar 

  25. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    Article  CAS  PubMed  Google Scholar 

  26. Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315:801–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine D, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Orit Barrett, Ella Abramovich, Victor Novack & Mahmoud Abu-Shakra

  2. Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Orit Barrett & Victor Novack

  3. Rheumatic Diseases Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Mahmoud Abu-Shakra

  4. Clalit Health Services, Beer Sheva, Israel

    Jacob Dreiher

Authors
  1. Orit Barrett
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  2. Ella Abramovich
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  3. Jacob Dreiher
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  4. Victor Novack
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  5. Mahmoud Abu-Shakra
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Correspondence to Mahmoud Abu-Shakra.

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All authors declare that they have no conflict of interest.

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The study was approved by the local ethics committee. All procedures performed in the participants were in accordance with ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was not required for this study (retrospective data).

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Barrett, O., Abramovich, E., Dreiher, J. et al. Short- and long-term mortality due to sepsis in patients with rheumatoid arthritis. Rheumatol Int 37, 1021–1026 (2017). https://doi.org/10.1007/s00296-017-3694-5

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  • DOI: https://doi.org/10.1007/s00296-017-3694-5

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