Bhat Ram, Sangathi Adarsh
Professor, Department of General Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Junior Resident, Department of General Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, Corresponding Author, Orcid: https://orcid.org/0009-0002-1507-710X.
J Assoc Physicians India. 2025 Jul;73(7):64-67. doi: 10.59556/japi.73.1033.
Sepsis results from the body's extreme response to pathogens and is associated with high mortality rates. Autoimmune diseases, treated with immunosuppressive medications, can weaken immune responses and increase susceptibility to sepsis. While older studies linked autoimmune disease and immunosuppressive treatment with higher mortality and longer hospital stays in sepsis patients, recent research suggests that these patients may not always have worse outcomes, in fact, they might have better outcomes, highlighting the need for further investigations.
(1) To investigate predictive factors of sepsis outcomes in individuals with underlying autoimmune diseases. (2) To quantify the severity of sepsis in the context of autoimmune diseases using the Sequential Organ Failure Assessment (SOFA) scoring system. (3) To evaluate the influence of autoimmune disease therapy on sepsis outcomes.
A 6-month prospective, observational cohort study was conducted with 83 participants at a single center. Patients were nearly evenly divided into autoimmune and nonautoimmune groups. Key variables including SOFA score at admission, sex distribution, mortality, and effect of autoimmune treatment regimens were analyzed using statistical methods such as Chi-squared tests, -tests, analysis of variance (ANOVA), and Bonferroni tests.
A comparison between patients with autoimmune conditions and those without revealed a significant difference in sex distribution, with 73.2% of autoimmune patients being female compared to 42.9% in the nonautoimmune group ( = 7.818, = 0.005). Analysis of the SOFA scores showed that the nonautoimmune group had significantly higher mean scores (6.05) compared to autoimmune group (4.15) ( = 0.006). Septic shock occurred less frequently in the autoimmune group (26.8%) than in the nonautoimmune group (42.9%) but was not statistically significant ( = 2.345, = 0.126). Mortality was lower in individuals with autoimmune diseases (14.6%) compared to those without (23.8%), but lacked statistical significance ( = 1.122, = 0.289). Different treatment types for autoimmune diseases did not significantly affect mean SOFA scores ( = 1.918, = 0.144), indicating no major impact on sepsis outcomes. However, analyses suggested that untreated autoimmune patients had higher average SOFA scores than those on disease-modifying antirheumatic drugs (DMARDs), warranting further investigation into treatment effects.
Our study showed significantly low SOFA scores and better sepsis outcomes in patients with autoimmune diseases, highlighting the mitigating effects of autoimmune diseases and their treatment in sepsis. Even though many observed differences, including mortality, septic shock, and autoimmune disease treatment effects on sepsis, were not statistically significant, it highlights the need for further research to confirm these trends and understand the underlying mechanisms.
脓毒症是机体对病原体的极端反应所致,与高死亡率相关。自身免疫性疾病患者接受免疫抑制药物治疗后,免疫反应会减弱,对脓毒症的易感性增加。虽然早期研究表明自身免疫性疾病和免疫抑制治疗会使脓毒症患者死亡率更高、住院时间更长,但近期研究显示这些患者的预后可能并不总是更差,事实上,他们可能有更好的预后,这凸显了进一步研究的必要性。
(1)研究患有潜在自身免疫性疾病的个体中脓毒症预后的预测因素。(2)使用序贯器官衰竭评估(SOFA)评分系统量化自身免疫性疾病背景下脓毒症的严重程度。(3)评估自身免疫性疾病治疗对脓毒症预后的影响。
在单一中心对83名参与者进行了为期6个月的前瞻性观察队列研究。患者几乎平均分为自身免疫组和非自身免疫组。使用卡方检验、t检验、方差分析(ANOVA)和邦费罗尼检验等统计方法分析入院时的SOFA评分、性别分布、死亡率以及自身免疫治疗方案的效果等关键变量。
自身免疫性疾病患者与非自身免疫性疾病患者的性别分布存在显著差异,73.2%的自身免疫性疾病患者为女性,而非自身免疫组为42.9%(χ² = 7.818,P = 0.005)。SOFA评分分析显示,非自身免疫组的平均评分(6.05)显著高于自身免疫组(4.15)(P = 0.006)。脓毒性休克在自身免疫组(26.8%)中的发生率低于非自身免疫组(42.9%),但差异无统计学意义(χ² = 2.345,P = 0.126)。自身免疫性疾病患者的死亡率(14.6%)低于无自身免疫性疾病的患者(23.8%),但差异无统计学意义(χ² = 1.122,P = 0.289)。自身免疫性疾病的不同治疗类型对平均SOFA评分无显著影响(F = 1.918,P = 0.144),表明对脓毒症预后无重大影响。然而,t检验表明未治疗的自身免疫性疾病患者的平均SOFA评分高于使用改善病情抗风湿药物(DMARDs)的患者,这值得进一步研究治疗效果。
我们的研究表明,自身免疫性疾病患者的SOFA评分显著较低,脓毒症预后较好,凸显了自身免疫性疾病及其治疗对脓毒症的缓解作用。尽管观察到的许多差异,包括死亡率、脓毒性休克以及自身免疫性疾病治疗对脓毒症的影响,均无统计学意义,但这凸显了进一步研究以证实这些趋势并了解潜在机制的必要性。