From the Department of Circulation and Medical Imaging (Askim, Gustad, Mohus, Solligård), NTNU, Norwegian University of Science and Technology; Clinic of Anesthesia and Intensive Care (Askim, Mohus, Solligård), St Olavs Hospital, Trondheim University Hospital; Mid-Norway Sepsis Research Group (Askim, Gustad, Paulsen, Mehl, Mohus, Damås, Solligård, Åsvold), NTNU, Norwegian University of Science and Technology, Trondheim; Department of Medicine (Gustad, Mehl), Levanger Hospital, Nord-Trøndelag Hospital Trust, Nord-Trøndelag; Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, NTNU (Paulsen, Damås), Norwegian University of Science and Technology; Department of Mental Health, NTNU (Reitan), Norwegian University of Science and Technology; Department of Psychiatry (Reitan), St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Chronic Disease Epidemiology (Dewan), Yale University School of Public Health, New Haven, Connecticut; Department of Infectious Diseases (Damås), St Olavs Hospital, Trondheim University Hospital; Department of Public Health and Nursing, NTNU (Åsvold), Norwegian University of Science and Technology; and Department of Endocrinologyn (Åsvold), St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Psychosom Med. 2018 Sep;80(7):673-679. doi: 10.1097/PSY.0000000000000619.
We examined whether anxiety and depression symptoms constitute increased risk of bloodstream infection (BSI), as a proxy for sepsis.
A general population with self-reported anxiety and depression symptoms was followed prospectively for hospital-verified BSI. Using multivariable Cox regression analysis, we estimated hazard ratios (HR) with 95% confidence intervals (CI) of BSI and BSI mortality, with and without statistical adjustment for comorbidities, BMI, and life-style factors that may confound or mediate the associations.
During 14.8 years median follow-up of 59,301 individuals, 1578 (2.7%) experienced BSI and 328 (0.55%) participants died within 30 days after a BSI. Severe depression symptoms were associated with a 38% increased risk of BSI, adjusted for age, sex, and education (HR = 1.38, 95% CI = 1.10-1.73). The HR was attenuated to 1.23 (0.96-1.59) after adjustment for comorbidities and to 1.15 (0.86-1.53) after additional adjustment for BMI and life-style factors. For severe anxiety symptoms, the corresponding HRs were 1.48 (1.20-1.83), 1.35 (1.07-1.70), and 1.28 (0.99-1.64). Moderate symptoms of depression and anxiety were not associated with increased BSI risk. The analysis of BSI mortality yielded imprecise results but suggested an increased risk of BSI mortality in participants with moderate depression symptoms.
Severe depression and anxiety symptoms were associated with a moderately increased risk of BSI. The association may, at least in part, be confounded or mediated by comorbidities, BMI, and life-style. Future research should investigate whether interventions targeting improved BMI and life-style may reduce the risk of BSI and sepsis in people with depression and anxiety symptoms.
我们研究了焦虑和抑郁症状是否会增加血流感染（BSI）的风险，BSI 可作为脓毒症的替代指标。
我们对自我报告有焦虑和抑郁症状的一般人群进行前瞻性随访，以确定医院确诊的 BSI。我们使用多变量 Cox 回归分析，估计了 BSI 和 BSI 死亡率的风险比（HR）及其 95%置信区间（CI），并分别在不调整和调整合并症、BMI 和可能混淆或介导关联的生活方式因素的情况下进行了估计。
在 59301 名参与者的中位随访 14.8 年期间，有 1578 人（2.7%）发生了 BSI，有 328 人（0.55%）在 BSI 后 30 天内死亡。严重抑郁症状与 BSI 的风险增加 38%相关，调整年龄、性别和教育因素后（HR=1.38，95%CI=1.10-1.73）。调整合并症后，HR 降至 1.23（0.96-1.59），进一步调整 BMI 和生活方式因素后，HR 降至 1.15（0.86-1.53）。对于严重焦虑症状，相应的 HR 分别为 1.48（1.20-1.83）、1.35（1.07-1.70）和 1.28（0.99-1.64）。中度抑郁和焦虑症状与 BSI 风险增加无关。BSI 死亡率的分析结果不够精确，但提示中度抑郁症状患者的 BSI 死亡率风险增加。
严重的抑郁和焦虑症状与 BSI 的风险中度增加相关。这种关联至少部分可能是由合并症、BMI 和生活方式因素混杂或介导的。未来的研究应调查针对改善 BMI 和生活方式的干预措施是否可以降低抑郁和焦虑症状患者发生 BSI 和脓毒症的风险。
