Abstract
BACKGROUND: 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.
OBJECTIVES: (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.
MATERIALS AND METHODS: 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, t-tests, analysis of variance (ANOVA), and post hoc Bonferroni tests.
RESULTS: 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 (χ2 = 7.818, p = 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) (p = 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 (χ2 = 2.345, p = 0.126). Mortality was lower in individuals with autoimmune diseases (14.6%) compared to those without (23.8%), but lacked statistical significance (χ2 = 1.122, p = 0.289). Different treatment types for autoimmune diseases did not significantly affect mean SOFA scores (F = 1.918, p = 0.144), indicating no major impact on sepsis outcomes. However, post hoc 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.
CONCLUSION: 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.