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. 2019 Dec;47(12):1735-1742.
doi: 10.1097/CCM.0000000000004020.

Allergic Immune Diseases and the Risk of Mortality Among Patients Hospitalized for Acute Infection

Philip A Verhoef  1   2 , Sivasubramanium V Bhavani  1 , Kyle A Carey  1 , Matthew M Churpek  1
Affiliations

Allergic Immune Diseases and the Risk of Mortality Among Patients Hospitalized for Acute Infection

Philip A Verhoef et al. Crit Care Med. 2019 Dec.

Abstract

Objectives: The immune response during sepsis remains poorly understood and is likely influenced by the host's preexisting immunologic comorbidities. Although more than 20% of the U.S. population has an allergic-atopic disease, the type 2 immune response that is overactive in these diseases can also mediate beneficial pro-resolving, tissue-repair functions. Thus, the presence of allergic immunologic comorbidities may be advantageous for patients suffering from sepsis. The objective of this study was to test the hypothesis that comorbid type 2 immune diseases confer protection against morbidity and mortality due to acute infection.

Design: Retrospective cohort study of patients hospitalized with an acute infection between November 2008 and January 2016 using electronic health record data.

Setting: Single tertiary-care academic medical center.

Patients: Admissions to the hospital through the emergency department with likely infection at the time of admission who may or may not have had a type 2 immune-mediated disease, defined as asthma, allergic rhinitis, atopic dermatitis, or food allergy, as determined by International Classification of Diseases, 9th Revision, Clinical Modification codes.

Interventions: None.

Measurements and main results: Of 10,789 admissions for infection, 2,578 (24%) had a type 2 disease; these patients were more likely to be female, black, and younger than patients without type 2 diseases. In unadjusted analyses, type 2 patients had decreased odds of dying during the hospitalization (0.47; 95% CI, 0.38-0.59, p < 0.001), while having more than one type 2 disease conferred a dose-dependent reduction in the risk of mortality (p < 0.001). When adjusting for demographics, medications, types of infection, and illness severity, the presence of a type 2 disease remained protective (odds ratio, 0.55; 95% CI, 0.43-0.70; p < 0.001). Similar results were found using a propensity score analysis (odds ratio, 0.57; 95% CI, 0.45-0.71; p < 0.001).

Conclusions: Patients with type 2 diseases admitted with acute infections have reduced mortality, implying that the type 2 immune response is protective in sepsis.

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Figures

Figure 1:
Figure 1:. Kaplan-Meier survival curve for patients admitted to the hospital with infection, with and without T2 diseases.
Discharged patients were assumed to be alive at 28 days; only patients who died in-hospital were considered to have suffered the event for this analysis.
Figure 2:
Figure 2:. Odds of death as a function of infection type in an otherwise fully adjusted model.
The fully adjusted model shown in Table 3 (but without adjustment for infection type) was used to determine the odds of death for specific infection types
See this image and copyright information in PMC

Comment in

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