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Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study

CONTEXT: 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. OBJECTIVE: To estimate infection risk in PAI due to Addison’s disease (AD) and congen...

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Autores principales: Tresoldi, Alberto S, Sumilo, Dana, Perrins, Mary, Toulis, Konstantinos A, Prete, Alessandro, Reddy, Narendra, Wass, John A H, Arlt, Wiebke, Nirantharakumar, Krishnarajah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046014/
https://www.ncbi.nlm.nih.gov/pubmed/31532828
http://dx.doi.org/10.1210/clinem/dgz006
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author Tresoldi, Alberto S
Sumilo, Dana
Perrins, Mary
Toulis, Konstantinos A
Prete, Alessandro
Reddy, Narendra
Wass, John A H
Arlt, Wiebke
Nirantharakumar, Krishnarajah
author_facet Tresoldi, Alberto S
Sumilo, Dana
Perrins, Mary
Toulis, Konstantinos A
Prete, Alessandro
Reddy, Narendra
Wass, John A H
Arlt, Wiebke
Nirantharakumar, Krishnarajah
author_sort Tresoldi, Alberto S
collection PubMed
description CONTEXT: 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. OBJECTIVE: To estimate infection risk in PAI due to Addison’s disease (AD) and congenital adrenal hyperplasia (CAH) in a primary care setting. DESIGN: Retrospective cohort study using UK data collected from 1995 to 2018. MAIN OUTCOME MEASURES: 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. RESULTS: 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]). CONCLUSIONS: 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.
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spelling pubmed-70460142020-02-28 Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study Tresoldi, Alberto S Sumilo, Dana Perrins, Mary Toulis, Konstantinos A Prete, Alessandro Reddy, Narendra Wass, John A H Arlt, Wiebke Nirantharakumar, Krishnarajah J Clin Endocrinol Metab Clinical Research Articles CONTEXT: 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. OBJECTIVE: To estimate infection risk in PAI due to Addison’s disease (AD) and congenital adrenal hyperplasia (CAH) in a primary care setting. DESIGN: Retrospective cohort study using UK data collected from 1995 to 2018. MAIN OUTCOME MEASURES: 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. RESULTS: 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]). CONCLUSIONS: 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. Oxford University Press 2019-09-18 /pmc/articles/PMC7046014/ /pubmed/31532828 http://dx.doi.org/10.1210/clinem/dgz006 Text en © Endocrine Society 2019. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research Articles
Tresoldi, Alberto S
Sumilo, Dana
Perrins, Mary
Toulis, Konstantinos A
Prete, Alessandro
Reddy, Narendra
Wass, John A H
Arlt, Wiebke
Nirantharakumar, Krishnarajah
Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study
title Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study
title_full Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study
title_fullStr Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study
title_full_unstemmed Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study
title_short Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia: A Primary Care Database Cohort Study
title_sort increased infection risk in addison’s disease and congenital adrenal hyperplasia: a primary care database cohort study
topic Clinical Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046014/
https://www.ncbi.nlm.nih.gov/pubmed/31532828
http://dx.doi.org/10.1210/clinem/dgz006
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