Association of autoimmune diseases with the occurrence and 28-day mortality of sepsis: an observational and Mendelian randomization study
Authors' conclusion
Both in observational and MR analysis, only rheumatoid arthritis is highly correlated with occurrence of sepsis. However, autoimmune disease was not associated with an increased 28-day mortality in patient with sepsis. Sepsis may increase the risk of developing psoriasis.
Study context
- Population
- Genome-wide association study (GWAS) data (MRC Integrative Epidemiology Unit (MRC-IEU), FinnGen) and patients with autoimmune disease in the MIMIC-IV databaseMIMIC-IV cohort
- Participants
- 2,537 participants
- Exposure
- Autoimmune diseases vs none, for sepsis occurrence and 28-day mortality
- Outcome
- Occurrence of sepsis and 28-day mortality of sepsis
- Follow-up
- 28 days
Methodological detailsunivariable, multivariable and reverse Mendelian randomization (MR), two-step mediation MR, multivariable logistic regression, MIMIC-IV database
- Univariable, multivariable and reverse MR
- Two-step mediation MR
- Multivariable logistic regression
- MIMIC-IV database
Main finding
As reported in the abstract
Sepsis occurrence (univariable MR)
Odds ratio (95% CI)P value
Type 1 diabetesgenetically predicted
1.036(1.023–1.048)
P = 9.130E-09Rheumatoid arthritisgenetically predicted
1.077(1.058–1.097)
P = 1.00E-15Celiac diseasepotential causal link
1.013(1.002–1.024)
P = 0.026Observational data: associations, not effects.
Further findings
Sepsis occurrence (multivariable MR)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Rheumatoid arthritisOnly independent association | 1.138 (1.044–1.240) | P = 3.36E-03 | |
| 0.512Odds ratio (log scale) |
Psoriasis onset after sepsis (reverse MR)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Sepsis | 1.084 (1.040–1.131) | P = 1.488E-04 | |
| 0.512Odds ratio (log scale) |
Sepsis occurrence (observational, MIMIC-IV)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Rheumatoid arthritisAdjusted for multiple confounders | 1.34 (1.11–1.64) | P = 0.003 | |
| Multiple sclerosisAdjusted for multiple confounders | 1.31 (1.03–1.68) | P = 0.02 | |
| 0.512Odds ratio (log scale) |
28-day sepsis mortality (MR)
- No causal link between autoimmune disorders and 28-day mortality from sepsis
28-day sepsis mortality (observational, MIMIC-IV)
- Autoimmune diseases not associated with 28-day mortality from sepsis
Original publication
Association of autoimmune diseases with the occurrence and 28-day mortality of sepsis: an observational and Mendelian randomization study. Crit Care. Published 5 December 2023. doi:10.
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