Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
J Clin Endocrinol Metab. 2020 Feb 1;105(2):418-29. doi: 10.1210/clinem/dgz006.
Mortality and infection-related hospital admissions are increased in patients with primary adrenal insufficiency (PAI). However, the risk of primary care-managed infections in patients with PAI is unknown.
To estimate infection risk in PAI due to Addison's disease (AD) and congenital adrenal hyperplasia (CAH) in a primary care setting.
Retrospective cohort study using UK data collected from 1995 to 2018.
Incidence of lower respiratory tract infections (LRTIs), urinary tract infections (UTIs), gastrointestinal infections (GIIs), and prescription counts of antimicrobials in adult PAI patients compared to unexposed controls.
A diagnosis of PAI was established in 1580 AD patients (mean age 51.7 years) and 602 CAH patients (mean age 35.4 years). All AD patients and 42% of CAH patients were prescribed glucocorticoids, most frequently hydrocortisone in AD (82%) and prednisolone in CAH (50%). AD and CAH patients exposed to glucocorticoids, but not CAH patients without glucocorticoid treatment, had a significantly increased risk of LRTIs (adjusted incidence rate ratio AD 2.11 [95% confidence interval (CI) 1.64-2.69], CAH 3.23 [95% CI 1.21-8.61]), UTIs (AD 1.51 [95% CI 1.29-1.77], CAH 2.20 [95% CI 1.43-3.34]), and GIIs (AD 3.80 [95% CI 2.99-4.84], CAH 1.93 [95% CI 1.06-3.52]). This was mirrored by increased prescription of antibiotics (AD 1.73 [95% CI 1.69-1.77], CAH 1.77 [95% CI 1.66-1.89]) and antifungals (AD 1.89 [95% CI 1.74-2.05], CAH 1.91 [95% CI 1.50-2.43]).
There is an increased risk of infections and antimicrobial use in PAI in the primary care setting at least partially linked to glucocorticoid treatment. Future studies will need to address whether more physiological glucocorticoid replacement modes could reduce this risk.
原发性肾上腺功能不全（PAI）患者的死亡率和感染相关住院率增加。然而，PAI 患者在初级保健管理下发生感染的风险尚不清楚。
在初级保健环境中估计由于 Addison 病（AD）和先天性肾上腺增生症（CAH）引起的 PAI 的感染风险。
使用英国 1995 年至 2018 年期间收集的数据进行回顾性队列研究。
与未暴露对照组相比，成人 PAI 患者下呼吸道感染（LRTIs）、尿路感染（UTIs）、胃肠道感染（GIIs）和抗生素处方计数的发生率。
在 1580 名 AD 患者（平均年龄 51.7 岁）和 602 名 CAH 患者（平均年龄 35.4 岁）中确诊为 PAI。所有 AD 患者和 42%的 CAH 患者接受了糖皮质激素治疗，最常使用的是 AD 中的氢化可的松（82%）和 CAH 中的泼尼松龙（50%）。接受糖皮质激素治疗的 AD 和 CAH 患者，但未接受糖皮质激素治疗的 CAH 患者，LRTIs 的风险显著增加（调整发病率比 AD 2.11 [95%置信区间（CI）1.64-2.69]，CAH 3.23 [95% CI 1.21-8.61]），UTIs（AD 1.51 [95% CI 1.29-1.77]，CAH 2.20 [95% CI 1.43-3.34]）和 GIIs（AD 3.80 [95% CI 2.99-4.84]，CAH 1.93 [95% CI 1.06-3.52]）。这与抗生素（AD 1.73 [95% CI 1.69-1.77]，CAH 1.77 [95% CI 1.66-1.89]）和抗真菌药（AD 1.89 [95% CI 1.74-2.05]，CAH 1.91 [95% CI 1.50-2.43]）处方的增加相对应。
在初级保健环境中，PAI 患者发生感染和使用抗生素的风险增加，至少部分与糖皮质激素治疗有关。未来的研究需要解决是否可以采用更生理性的糖皮质激素替代模式来降低这种风险。
