Patompong Ungprasert1, Cynthia S Crowson1,2, Eric L Matteson1,3. 1. 1 Division of Rheumatology, Department of Internal Medicine. 2. 2 Division of Biomedical Statistics and Informatics, Department of Health Science Research; and. 3. 3 Division of Epidemiology, Department of Health Science Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Abstract
RATIONALE: Patients with sarcoidosis may have an increased risk of infection similar to other immune-mediated disorders. However, the data are still limited. OBJECTIVES: To investigate the risk of hospitalized infection among patients with sarcoidosis, using a population-based cohort. METHODS: Using the Rochester Epidemiology Project record-linkage system, a cohort of incident cases of sarcoidosis in Olmsted County, Minnesota from 1976 to 2013 was identified. Diagnosis was confirmed by individual medical record review. For each patient with sarcoidosis, a sex- and age-matched comparator without sarcoidosis was randomly selected from the same population. Medical records of cases and comparators were individually reviewed for hospitalized infection that occurred after the index date. The cumulative incidence of hospitalized infection overall and by type of infection, adjusted for the competing risk of death, was estimated. Cox models were used to compare the rate of first hospitalized infection between cases and comparators and to evaluate the association between use of immunosuppressive agents and hospitalized infection among cases. RESULTS: Three hundred and forty-five cases and 345 comparators were identified. Patients with sarcoidosis had a higher risk of a hospitalized infection with a hazard ratio (HR) of 2.00 (95% confidence interval [CI], 1.41-2.84), adjusted for age, sex, and calendar year of index date. Use of oral glucocorticoids was a significant predictor of hospitalized infection with an HR of 3.03 (95% CI, 1.33-6.90) for oral glucocorticoids not exceeding 10 mg/day and an HR of 4.48 (95% CI, 1.54-13.03) for oral glucocorticoids greater than 10 mg/day. CONCLUSIONS: Patients with sarcoidosis are at increased risk of hospitalized infection. Glucocorticoid therapy is strongly associated with this increased risk.
RATIONALE: Patients with sarcoidosis may have an increased risk of infection similar to other immune-mediated disorders. However, the data are still limited. OBJECTIVES: To investigate the risk of hospitalized infection among patients with sarcoidosis, using a population-based cohort. METHODS: Using the Rochester Epidemiology Project record-linkage system, a cohort of incident cases of sarcoidosis in Olmsted County, Minnesota from 1976 to 2013 was identified. Diagnosis was confirmed by individual medical record review. For each patient with sarcoidosis, a sex- and age-matched comparator without sarcoidosis was randomly selected from the same population. Medical records of cases and comparators were individually reviewed for hospitalized infection that occurred after the index date. The cumulative incidence of hospitalized infection overall and by type of infection, adjusted for the competing risk of death, was estimated. Cox models were used to compare the rate of first hospitalized infection between cases and comparators and to evaluate the association between use of immunosuppressive agents and hospitalized infection among cases. RESULTS: Three hundred and forty-five cases and 345 comparators were identified. Patients with sarcoidosis had a higher risk of a hospitalized infection with a hazard ratio (HR) of 2.00 (95% confidence interval [CI], 1.41-2.84), adjusted for age, sex, and calendar year of index date. Use of oral glucocorticoids was a significant predictor of hospitalized infection with an HR of 3.03 (95% CI, 1.33-6.90) for oral glucocorticoids not exceeding 10 mg/day and an HR of 4.48 (95% CI, 1.54-13.03) for oral glucocorticoids greater than 10 mg/day. CONCLUSIONS:Patients with sarcoidosis are at increased risk of hospitalized infection. Glucocorticoid therapy is strongly associated with this increased risk.
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