The American journal of medicine · 2026
Risk of infection-related hospitalization is more than doubled in Cushing's syndrome vs matched controls.
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Akirov Amit, Atamna Alaa, Rudman Yaron, Kushnir Shiri, Shochat Tzippy, Fleseriu Maria
Аннотация
BACKGROUND: Cushing's syndrome is associated with immune dysfunction and increased susceptibility to infection, yet risk of infection-related hospitalization remains unclear. We evaluated infection-related hospitalization in Cushing's syndrome versus controls.
METHODS: Using the Clalit Health Services database, 609 patients with Cushing's syndrome were identified and matched to 3018 controls by age, sex, socioeconomic status, and body mass index. The primary outcome was infection-related hospitalization. Competing-risk models were used with death as a competing event. Analyses were performed according to etiology, remission, and infection subtype.
RESULTS: During mean follow-up of 13.4 years in patients with Cushing's syndrome and 13.9 years in controls, infection-related hospitalization occurred in 14.1% vs 5.9% (86/609 vs 178/3018), with incidence rates of 10.5 vs 4.2 per 1000 person-years. Patients with Cushing's syndrome had a higher risk of infection-related hospitalization (HR 2.5, 95% CI 1.9-3.2), observed in both Cushing's disease (HR 3.8, 95% CI 2.5-5.7) and adrenal disease (HR 2.3, 95% CI 1.5-3.6). Respiratory and genitourinary infections were the most common causes, and opportunistic infections were more frequent in Cushing's syndrome (12.5% vs 5.6%, P = 0.04). Patients in remission remained at increased risk (HR 2.5, 95% CI 1.6-3.8), while older age and higher body mass index independently predicted hospitalization, with most infections occurring in patients aged ≥55 years and body mass index ≥25 kg/m².
CONCLUSION: Patients with Cushing's syndrome have an excess risk of infection-related hospitalization affecting both common and opportunistic infections and risk persists after remission. These findings support ongoing infection surveillance and preventive measures.
METHODS: Using the Clalit Health Services database, 609 patients with Cushing's syndrome were identified and matched to 3018 controls by age, sex, socioeconomic status, and body mass index. The primary outcome was infection-related hospitalization. Competing-risk models were used with death as a competing event. Analyses were performed according to etiology, remission, and infection subtype.
RESULTS: During mean follow-up of 13.4 years in patients with Cushing's syndrome and 13.9 years in controls, infection-related hospitalization occurred in 14.1% vs 5.9% (86/609 vs 178/3018), with incidence rates of 10.5 vs 4.2 per 1000 person-years. Patients with Cushing's syndrome had a higher risk of infection-related hospitalization (HR 2.5, 95% CI 1.9-3.2), observed in both Cushing's disease (HR 3.8, 95% CI 2.5-5.7) and adrenal disease (HR 2.3, 95% CI 1.5-3.6). Respiratory and genitourinary infections were the most common causes, and opportunistic infections were more frequent in Cushing's syndrome (12.5% vs 5.6%, P = 0.04). Patients in remission remained at increased risk (HR 2.5, 95% CI 1.6-3.8), while older age and higher body mass index independently predicted hospitalization, with most infections occurring in patients aged ≥55 years and body mass index ≥25 kg/m².
CONCLUSION: Patients with Cushing's syndrome have an excess risk of infection-related hospitalization affecting both common and opportunistic infections and risk persists after remission. These findings support ongoing infection surveillance and preventive measures.