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. 2017 Jul 13;21(1):185.
doi: 10.1186/s13054-017-1767-1.

Association of baseline steroid use with long-term rates of infection and sepsis in the REGARDS cohort

Ninad S Chaudhary  1   2 , John P Donnelly  1   3   2 , Justin X Moore  1   2 , John W Baddley  4 , Monika M Safford  5   6 , Henry E Wang  7   8
Affiliations

Association of baseline steroid use with long-term rates of infection and sepsis in the REGARDS cohort

Ninad S Chaudhary et al. Crit Care. .

Abstract

Background: Prior studies associate steroid use with infection risk but were limited to select populations and short follow-up periods. The association of steroid use with long-term risk of community-acquired infections is unknown. We sought to determine the association of steroid risk with long-term risks of community- acquired infections and sepsis.

Methods: We used data on 30,239 adults aged ≥ 45 years old from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The primary exposure was oral or injectable steroid use, determined from medication inventory obtained at baseline in-home visit. The primary outcome was time to first infection event during 2003-2012, determined through adjudicated review of hospital records. We determined associations between baseline steroid use and first infection hospitalization events using Cox proportional hazards models, adjusting for demographics, health behaviors, chronic medical conditions, and medication adherence. Among the first infection hospitalization events, we also determined the association between baseline steroid use and sepsis.

Results: Steroid use was reported in 2.24% (n = 677) of the study population. There were 2593 incident infection events during the 10-year follow-up period. Infection incidence rates were higher for steroid than non-steroid users (37.99 vs. 13.79 per 1000 person-years). Steroid use was independently associated with increased risk of infection (adjusted HR 2.10, 95% CI: 1.73-2.56). Among first-infection events, steroid use was associated with increased odds of sepsis (adjusted OR 2.11, 95% CI: 1.33-3.36). The associations persisted in propensity matched analyses as well as models stratified by propensity score and medication adherence.

Conclusions: In this population-based cohort study, baseline steroid use was associated with increased long-term risks of community-acquired infections and sepsis.

Keywords: Epidemiology; Infection; Longitudinal Study; Prevention; Steroids.

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Conflict of interest statement

Ethical approval and consent to participate

The Institutional Review Board of the University of Alabama at Birmingham approved this study. We obtained informed consent from all participants of the study during baseline visit, and we also obtained consent for subsequent blood samples.

Consent for publication

Not applicable.

Competing interests

Dr. Safford reports the following potential conflicts of interest: Amgen - salary support to study patterns of statin use in Medicare and other large databases; diaDexus - salary support for a research grant on lipids and CHD outcomes; diaDexus - consulting to help with FDA application; NIH, AHRQ - salary support for research grants. Drs. Wang, Chaudhary, Moore, Donnelly and Baddley do not report any related conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves depicting proportion of infection-free period among steroid users and non-users. Left graph depicts entire cohort population (n = 30,189). Right graph depicts steroid users and non-users matched on propensity score using nearest neighbor matching with caliper method (n = 1072)
See this image and copyright information in PMC

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