期刊
PSYCHOSOMATIC MEDICINE
卷 77, 期 1, 页码 93-100出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PSY.0000000000000120
关键词
sepsis; infection; stress; epidemiology; depression
资金
- National Institute for Nursing Research [R01-NR012726]
- National Center for Research Resources [UL1-RR025777]
- Center for Clinical and Translational Science
- Lister Hill Center for Health Policy of the University of Alabama at Birmingham
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service [U01-NS041588]
- Agency for Healthcare Research and Quality, Rockville, MD [2 T32 HS013852]
- Amgen
- diaDexus
- National Institutes of Health
- Agency for Healthcare Research and Quality
Objective To characterize the relationship between stress and future risk of sepsis. We also evaluated the role of depression in this relationship. Methods We used population-based data on 30,183 participants in the Reasons for Geographic and Racial Differences in Stroke cohort, characterizing stress using the Perceived Stress Scale (PSS) and depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). We identified incident sepsis events as hospitalizations for a serious infection with the presence of at least two systemic inflammatory response syndrome criteria. We assessed associations between PSS and incidence of sepsis for 1 and 10 years of follow-up, adjusting for demographics and chronic medical conditions and assessing the role of health behaviors and CES-D in these relationships. Results In 2003 to 2012, 1500 participants experienced an episode of sepsis. Mean PSS and CES-D scores were 3.2 (2.9) and 1.2 (2.1). PSS was associated with increased 1-year adjusted incidence of sepsis (hazard ratio [HR] = 1.21 per PSS standard deviation, 95% confidence interval = 1.06-1.38); multivariable adjustment for health behaviors and CES-D did not change this association (1.20, 1.03-1.39). PSS was also associated with increased 10-year adjusted incidence of sepsis (HR = 1.07 per PSS standard deviation; 95% confidence interval = 1.02-1.13). Multivariable adjustment showed that health behaviors did not affect this long-term association, whereas the addition of CES-D reduced the association between PSS and sepsis during 10-year follow-up (HR = 1.04, 0.98-1.11). Conclusions Increased stress was associated with higher 1-year adjusted incidence of sepsis, even after accounting for depressive symptoms. The association between stress and 10-year adjusted incidence of sepsis was also significant, but this association was reduced when adjusting for depressive symptoms. Reduction of stress may limit short-term sepsis risk.
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