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 β2-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 β2-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 β2-adrenoceptor agonists.