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

Background: Patients with chronic obstructive pulmonary disease (COPD) who survive sepsis remain immunocompromised and are at increased risk of subsequent viral infections, including influenza and respiratory syncytial virus (RSV). Objective: This study aimed to address the 1-year risk of viral infections after sepsis in patients with COPD through the use of a federated database, TriNetX. Design: A propensity score-matched (PSM) retrospective cohort study. Methods: We used data of 903,683 COPD patients and identified 113,589 who experienced sepsis. The risk of distinct viral infections, including herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), RSV and influenza, within 1 year post-sepsis was analyzed, with the employment of PSM to minimize confounding. The effect of vaccination was also assessed to determine its protective efficacy. Results: A total of 98,883 COPD patients with sepsis and 1:1 matched COPD without sepsis were eligible for analyses. COPD patients with sepsis had consistently higher risk for viral infections within 1 year after the sepsis compared with COPD patients without sepsis. The hazard ratios (HRs) were as follows: HSV 1.936 (95% CI: 1.775–2.112), VZV 3.050 (2.489–3.737), CMV 2.101 (1.832–2.410), RSV 3.297 (3.158–3.443), and Influenza 3.197 (3.071–3.328). Sensitivity analysis demonstrated the consistently elevated risks across sepsis with varying severities. We further explored the protective effect of vaccinations among patients with COPD and found the significant protective effect of VZV glycoprotein E (HR 0.724, 95% CI: 0.595–0.882), RSV prefusion F protein-based vaccine (HR 0.676, 95% CI: 0.563–0.812) and influenza vaccine (HR 0.709, 95% CI: 0.649–0.776). Conclusion: COPD patients recovering from sepsis remain at increased risk of viral infections, highlighting the importance of targeted preventive strategies, including vaccination.