Does Sepsis Risk Increase With Short-term Oral Corticosteroid Use?

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Sepsis, venous thromboembolism, and fracture were identified using ICD-9-CM diagnosis codes.
Sepsis, venous thromboembolism, and fracture were identified using ICD-9-CM diagnosis codes.

Short-term use of oral corticosteroids is associated with an increased risk of sepsis, venous thromboembolism, and fracture, even at relatively low doses, according to a study published in the BMJ.

Akbar K Waljee, MD, from the VA Center for Clinical Management Research in Ann Arbor, Michigan, and colleagues conducted a retrospective cohort study and self-controlled case series to determine the frequency of prescriptions for short-term use of oral corticosteroids, as well as adverse events (sepsis, venous thromboembolism, and fractures) associated with their use. 

They identified all adults aged 18 to 64 years who were continuously enrolled in the Clinformatics DataMart database between January 1, 2012, and December 31, 2014 (n=2,234,931). Patients were also required to have at least one year of continuous enrollment before the study period to capture past use of corticosteroids and baseline comorbid conditions.

The primary outcome was an outpatient prescription for an oral formulation of corticosteroids for less than 30 days, as obtained from detailed information in each pharmacy claim. Secondary outcomes included incidence rates of adverse events in corticosteroid users and nonusers, and incidence rate ratios for adverse events within 30 days and 31- to 90-day risk periods after drug initiation.

Sepsis, venous thromboembolism, and fracture were identified using ICD-9-CM diagnosis codes that reflected acute presentations, with chronic or personal history codes not included. For the entire cohort, the authors calculated incidence rates of adverse events per 1000 person years at risk for corticosteroid users and nonusers.

Of 1,548,945 adults included, 327,452 (21.1%) received at least one outpatient prescription for short-term use of oral corticosteroids during the 3-year period. Use was more frequent among older patients, women, and white adults, with significant regional variation. The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies.  Within 30 days of drug initiation, sepsis rates increased (incidence rate 5.30), venous thromboembolism (3.33), and fracture (1.87), which diminished over the subsequent 31 to 90 days.  

“Over a 3 year period, approximately 1 in 5 American adults in a commercially insured plan used oral corticosteroids for less than 30 days,” the authors said. “The short term use of these drugs was associated with increased rates of sepsis, venous thromboembolism, and fracture; even at relatively low doses.”

Reference

  1. Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 12 April 2017. doi: https://doi.org/10.1136/bmj.j1415
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