Although studies have been completed examining the cause of death and rates of sepsis in patients with chronic obstructive pulmonary disease (COPD) no study has been completed examining COPD as a risk factor for sepsis. The goal of our study was to prospectively examine COPD as a risk factor for sepsis.
Data from the Atherosclerosis Risk in Communities (ARIC) study (a prospective study of 15,792 U.S. adults age 45-65 years old) were used in this analysis, with up to 11 years of follow-up data available. A diagnosis of COPD was made using modified GOLD criteria (we added a “restrictive” category consisting of people with an FEV1/FVC > 70% and an FVC < 80% predicted). Episodes of sepsis or pneumonia were obtained using diagnostic codes (ICD-9 codes 038 and 480-487, respectively) from hospital discharge. Out of 15,586 patients analyzed there were 136 documented cases of sepsis. A logistic regression, controlling for age, sex, cigarette smoking, body mass index, education level, family income was completed using the SUDAAN software package. A second regression model added hospitalization for pneumonia to the above noted variables.
The table depicts the classification of lung disease with incidence of sepsis, pneumonia, odds ratio for sepsis with 95% confidence intervals (controlling for the factors noted in the methods) and odds ratio for sepsis when controlled for pneumonia. Pneumonia was a very strong predictor of sepsis (odds ratio 22.7, 95% CI 14.5, 35.4).
Patients with GOLD stage 2 or higher COPD and those with restrictive disease had an increased risk for sepsis in this cohort. After controlling for pneumonia, the risk was attenuated, and only significant in patients with restrictive disease.
These findings suggest that most, but not all, of the increased risk of sepsis among patients with COPD is related to their increased risk of developing pneumonia.
Lung DiseaseN% Sepsis% PneumoniaOR for SepsisOR controlled for PneumoniaGold Stage 3 & 42813. 612.84.2 (2.0-9.1)1.9 (0.8-4.4)Gold Stage 2149184.108.40.206 (1.3-3.8)1.7 (0.9-2.9)Gold Stage 1168220.127.116.11 (0.5-1.9)0.8 (0.4-1.7)Gold Stage 021918.104.22.168 (0.9-2.6)1.5 (0.8-2.5)Restrictive13252.21.73.3 (2.0-5.5)2.4 (1.4-4.2)Normal86090.50.91.01.0
David Hasselbacher, None.