Sjögren’s Patients More Likely to Need Hospital Care Due to Infections

Risk of hospitalization may be reduced with preventive measures: study

Steve Bryson, PhD avatar

by Steve Bryson, PhD |

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People with Sjögren’s syndrome are more likely to require inpatient hospital care for infections acquired in the community, especially those of the airways and intestines, according to a large nationwide French study.

“[Sjögren’s] patients had a significantly higher incidence rate of hospitalization for bronchopulmonary infections compared with matched [healthy people],” the researchers wrote.

Hospitalizations for opportunistic infections, such as the chickenpox/shingles virus (zoster) and mycobacterial infections, also are higher in this patient population, the study found. Overall, the incidence of hospitalization for a first infection was 98% higher for those with Sjögren’s than among healthy people.

Researchers suggested that preventive measures and vaccination campaigns may decrease the burden of infections in Sjögren’s patients.

The study, “Hospitalizations for infections in primary Sjögren’s syndrome patients: a nationwide incidence study,” was published in the journal Annals of Medicine.

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Sjögren’s syndrome is an autoimmune disease primarily marked by inflammation of the tear and salivary glands, which leads to its hallmark symptoms of dry eyes and mouth. The condition also is associated with joint pain, skin rashes, vaginal dryness, dry cough, fatigue, and chronic pain.

Life-threatening complications of Sjögren’s include blood cancers, cardiovascular diseases, and infections, especially in the airways (bronchopulmonary). In fact, infections account for about 30% of Sjögren’s-related hospitalizations.

Inpatient hospital care for Sjögren’s patients

Although the impact of infections on outcomes associated with other autoimmune diseases has been widely described, little is known about the incidence of severe infections requiring hospitalization in people with Sjögren’s, according to the researchers, from the University of Montpellier, in France.

“A better description of the risks of specific infections in [Sjögren’s syndrome] patients could help to tailor preventive strategies,” the scientists wrote.

To learn more, the team collected data from the French Health insurance database regarding newly hospitalized Sjögren’s patients between 2011 and 2018. The researchers then compared the incidence of hospitalization for several types of infections between 25,661 Sjögren’s patients and 252,543 age- and sex-matched hospitalized patients without Sjögren’s who served as controls.

Most participants were female (87.7%), with a mean age of 60 and a median follow-up of about four years. Those with Sjögren’s were more likely to be obese, require dialysis, and have high blood pressure, diabetes, cardiovascular diseases, blood cancers, and neuropsychiatric conditions.

Lung diseases also were more prevalent among Sjögren’s patients than controls, including chronic obstructive pulmonary disease (1.72% vs. 0.48%), a chronic inflammatory lung disease, and interstitial lung disease (2.71% vs. 0.06%), which is characterized by lung inflammation and scarring.

Within the study period, 2,254 individuals with Sjögren’s (8.78%) had at least one hospitalization for an infection acquired in the community.

Overall, the incidence of hospitalizations for a first community infection was 29% higher in Sjögren’s patients compared with controls, after adjusting for socio-economic status, past cardiovascular or lung diseases, and blood cancer factors. Leading causes of hospitalization included infections of the intestines, airways, kidneys, teeth, and ears/nose/throat (ENT).

The incidence of hospitalizations due to intestinal infections was 18% higher in Sjögren’s patients than in controls. Similar results were seen for airway infections, with a 50% increased incidence for pneumonia, 70% for bronchitis, and 98% for influenza (flu).

Hospitalization rates for kidney infections were also 55% higher in Sjögren’s patients. Hospitalization rates for skin infections were almost four times higher in Sjögren’s patients, and for dental and ENT infections were 27% higher compared with controls.

The team then evaluated the incidence of opportunistic infections, which are those that typically arise in people who have a weakened or compromised immune system but may not cause disease in a healthy person. Over the course of the study, 104 Sjögren’s patients (0.04%) experienced at least one opportunistic infection.

The hospitalization incidence for a first opportunistic infection was 98% higher in people with Sjögren’s than in controls. Hospitalizations for zoster (chickenpox/shingles) were 3.32 times higher in Sjögren’s patients than in controls, 4.35 times higher for mycobacteria, and 2.54 times for tuberculosis. Notably, the hospitalization rate for interstitial lung disease was more than nine times higher in Sjögren’s patients.

The incidence of in-hospital mortality in Sjögren’s patients was similar to that of controls for pneumonia, and infections of the kidney, intestines, or dental and ENT, regardless of adjustments.

“In this large nationwide study, hospitalized [Sjögren’s syndrome] patients showed a higher risk of hospitalization for community infections, especially bronchopulmonary infections and intestinal infections, compared with matched controls,” the team wrote.

“A targeted vaccination campaign against respiratory pathogens and strict management of sicca syndrome could be beneficial in reducing this risk,” they concluded.