Researchers have identified in a new study that patients suffering from chronic obstructive pulmonary disease (COPD) who recover from sepsis are at much greater risk of contracting viral infections one year post-recovery. The study points out that this increased risk is still present even after clinical stabilization and identifies the importance of targeting vaccine efforts at this high-risk group. Carried out with real-world data from the TriNetX federated database, this large-scale analysis presents that sepsis survival in COPD is associated with heightened vulnerability to infections like influenza, respiratory syncytal virus (RSV), and varicella-zoster virus (VZV). The study was published in the journal of Therapeutic Advances in Respiratory Disease by Tzu-I C. and colleagues.
COPD is an inflammatory chronic lung disease that compromises immune defenses and predisposes patients to infection. When such patients develop sepsis, an overwhelming systemic inflammatory response to infection, their immune capacity can further decline, leading to prolonged immunosuppression despite recovery from the clinic. Secondary viral infections caused by this ongoing immune dysfunction contribute significantly to increased morbidity and healthcare utilization in COPD populations.
This propensity score-matched (PSM) retrospective cohort study examined patient information within the TriNetX global research network, which comprises millions of electronic health records. The researchers identified 113,589 patients with COPD who had developed sepsis among 903,683 COPD patients.
Following 1:1 PSM to control confounding, there were 98,883 COPD and sepsis patients compared with matched COPD controls without sepsis. The incidence of viral infections at 1 year, such as herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), respiratory syncytial virus (RSV), and influenza, was measured by the study. The study also measured the vaccine's protective effects—namely VZV glycoprotein E vaccine, RSV prefusion F protein-based vaccine, and influenza vaccine—on lowering the risk of infection among post-sepsis patients with COPD.
Results
The results indicated that surviving sepsis patients with COPD were significantly more likely to experience multiple viral infections in the first year than those without sepsis.
The adjusted hazard ratios (HRs) showed a similar pattern of increased susceptibility for all studied viruses:
Herpes simplex virus (HSV): HR = 1.936 (95% CI 1.775–2.112)
Varicella-zoster virus (VZV): HR = 3.050 (95% CI 2.489–3.737)
Cytomegalovirus (CMV): HR = 2.101 (95% CI 1.832–2.410)
Respiratory syncytial virus (RSV): HR = 3.297 (95% CI 3.158–3.443)
Influenza: HR = 3.197 (95% CI 3.071–3.328)
Even with adjustments for sepsis severity in sensitivity analyses, the increased risks persisted, indicating a strong association between sepsis-induced immune dysfunction and resultant viral susceptibility.
This large cohort study illustrates that COPD patients surviving sepsis are significantly at risk for viral infections such as HSV, VZV, CMV, RSV, and influenza in the first year following the episode. The study also indicates that vaccinations reduce risks to a great extent, further supporting the necessity of targeted vaccine and infection monitoring methods in COPD patients following sepsis. These results underscore the long-term immunological effect of sepsis in chronic respiratory illness and indicate vaccination as a critical element of care after sepsis to enhance patient results.
Reference:
Chuang TI, Chao WC. Higher risk of viral infections in chronic obstructive pulmonary disease patients recovering from sepsis compared to non-sepsis patients: a propensity score-matched observational study. Ther Adv Respir Dis. 2025 Jan-Dec;19:17534666251385679. doi: 10.1177/17534666251385679. Epub 2025 Oct 15. PMID: 41090984; PMCID: PMC12536156.
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