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Asthma protects against sepsis, sepsis-related mortality
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Patients with asthma have a lower risk of acquiring and/or dying from sepsis, according to research presented at the American Thoracic Society International Conference.
“While classical type 2 helper cell immune responses are one major mechanism underlying asthma, other contributing mechanisms include activation of interleukin-17–mediated neutrophilic inflammation, and innate toll-like receptor responses to pathogens,” Joe G. Zein, MD, from the department of pulmonary medicine at Cleveland Clinic, and colleagues wrote. “These pathways are important to normal host response to pathogens and may potentially benefit asthmatics.”
Zein and colleagues evaluated the effect of asthma on septicemia, sepsis, severe sepsis and septic shock, as well as mortality in patients hospitalized for pneumonia, urinary tract infection (UTI) or skin and soft tissue infection (SSTI) by using data from the 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS), which represented 20% of all hospital discharges in the United States. Additional data sources, including the 2007, 2008 and 2011 NIS and Cleveland Clinic Health System (CCHS) admissions between 2010 and 2014, were used to validate the results. Patients with remote or current smoking history were excluded.
Data from the NIS 2012 sample indicated that 23,386 (10%) patients with asthma and 203,603 (90%) without asthma were hospitalized with either pneumonia, UTI or SSTI. Lower hospital mortality (aOR = 0.41; 95% CI, 0.37-0.45), as well as lower incidences of septicemia (aOR = 0.6; 95% CI, 0.58-0.61), sepsis (aOR = 0.59; 95% CI, 0.56-0.62), severe sepsis (aOR = 0.6; 95% CI, 0.58-0.63) and septic shock (aOR = 0.74; 95% CI, 0.71-0.78) was observed in patients with asthma. Within each specific type of infection, risk reductions were significant, according to the researchers. Asthma patients also had a lower risk for ICU admission (aOR = 0.8; 95% CI, 0.64-0.99) and acute kidney injury (aOR = 0.65; 95% CI, 0.63-0.68). In addition, asthma was associated with shorter hospital length of stay and in turn, lower in-hospital costs.
“The results in this study, adjusted to gender, age, income, race, and comorbidities, across four different years are consistent across five independent large datasets that include a total of 99,257 patients with asthma among nearly 1 million hospitalized individuals,” Zein told Healio Internal Medicine. “Differences in sample size, exclusion criteria and methodology may underlie the differences in our results as compared to previously published reports that associated asthma with higher risk of invasive pneumococcal and non-respiratory infections. Future work on types of immune responses that benefit asthma may suggest approaches to avoid sepsis related outcomes in non-asthmatic people.” – by Alaina Tedesco
Reference:
Zein JG, et al. “Asthma is associated with a lower risk of sepsis and sepsis-related mortality among hospitalized atients.” Presented at: American Thoracic Society International Conference; May 19-24, 2017; Washington, D.C.
Disclosure: Zein reports no relevant financial disclosures.