Risk of sepsis in patients with amyotrophic lateral sclerosis: a population-based retrospective cohort study in Taiwan

OBJECTIVES: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease, and sepsis is a frequent cause of death in hospitalised patients. We investigated the relationship between ALS and the subsequent risk of sepsis. DESIGN: A retrospective cohort analysis. SETTING: Patients with ALSs diagnosed between 2000 and 2010 in Taiwan National Health Insurance Research Database. PARTICIPANTS: We included 701 and 2804 patients as the ALS and the non-ALS groups, respectively. OUTCOME MEASURES: The risk of sepsis was calculated by Cox proportional hazards regression model. RESULTS: During the follow-up period, the incidence density rates were 77.8 and 11.1 per 1000 person-years in the ALS and non-ALS groups, respectively. After adjusting for sex, age, Charlson comorbidity index score, life-support measures, and β(2)-adrenoceptor agonists treatment, the ALS group had a higher risk of sepsis (HR=3.42; 95% CI 2.60 to 4.50) than the non-ALS group. An increase of the risk was observed in patients with ALS receiving life support treatment measures, whereas a decrease of the risk was associated with treatment of β(2)-adrenoceptor agonists. CONCLUSIONS: The risk of sepsis is associated with a prior ALS diagnosis, and may be increased by the use of life support measures and decreased by β(2)-adrenoceptor agonists.