Risk of first and recurrent serious infection in sarcoidosis: a Swedish register-based cohort study
- Marios Rossides1⇑,
- Susanna Kullberg2,3,
- Anders Eklund2,3,
- Daniela Di Giuseppe1,
- Johan Grunewald2,3,
- Johan Askling1,4 and
- Elizabeth V. Arkema1
- 1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- 2Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- 3Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
- 4Rheumatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
- Dr Marios Rossides, Karolinska Institutet, Department of Medicine Solna, Clinical Epidemiology Division, Karolinska University Hospital T2, 171 76 Stockholm, Sweden. E-mail: marios.rossides{at}ki.se
Abstract
Serious infections (SI) impair quality of life and increase costs. Our aim was to determine if sarcoidosis is associated with a higher rate of SI and whether this varies by age, sex, time since diagnosis, or treatment status around diagnosis.
We compared individuals with sarcoidosis (≥2 ICD codes in the Swedish National Patient Register 2003–2013; n=8737) and general population comparators matched 10:1 on age, sex, and residential location (n=86 376). Patients diagnosed 2006–2013 who were dispensed ≥1 immunosuppressant ±3 months from diagnosis (Prescribed Drug Register) were identified. Cases and comparators were followed in the National Patient Register for hospitalisations for infection. Using Cox and flexible parametric models, we estimated adjusted hazard ratios and 95% confidence intervals (aHR;CI) for first and recurrent SIs (new SI >30 days after the previous).
We identified 895 first SIs in sarcoidosis and 3881 in comparators. The rate of SI was 1.8-fold increased in sarcoidosis compared to the general population (aHR 1.81 [95%CI 1.65, 1.98]). The aHR was higher in females than males and during the first 2 years of follow-up. Sarcoidosis cases treated with immunosuppressants around diagnosis had a threefold increased risk whereas non-treated patients had a 50% increased risk. The rate of SI recurrence was 2.8-fold higher in cases than in comparators.
SIs are more common in sarcoidosis than in the general population, particularly during the first few years after diagnosis. Patients who need immunosuppressant treatment around diagnosis are twice as likely to develop a serious infection than those who do not.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Rossides has nothing to disclose.
Conflict of interest: Dr. Kullberg has nothing to disclose.
Conflict of interest: Dr. Eklund has nothing to disclose.
Conflict of interest: Dr. Di Giuseppe has nothing to disclose.
Conflict of interest: Dr. Grunewald reports grants from Swedish Heart-Lung Foundation (Hjärt-Lungfonden), during the conduct of the study.
Conflict of interest: Dr. Askling has nothing to disclose.
Conflict of interest: Dr. Arkema reports grants from Swedish Heart-Lung Foundation (Hjärt-Lungfonden), during the conduct of the study.
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- Received March 19, 2020.
- Accepted April 22, 2020.
- Copyright ©ERS 2020