Physical Activity and the incidence of sepsis: A 10-year observational study among 4 million adults

Kyoung Hwa Lee; Eun Hwa Lee; Kyu-Na Lee; Yebin Park; Young Goo Song; Kyung Do Han; Sang Hoon Han

doi:10.1016/j.jmii.2024.04.009

Physical Activity and the incidence of sepsis: A 10-year observational study among 4 million adults

J Microbiol Immunol Infect. 2024 Apr 26:S1684-1182(24)00077-X. doi: 10.1016/j.jmii.2024.04.009. Online ahead of print.

Authors

Kyoung Hwa Lee¹, Eun Hwa Lee¹, Kyu-Na Lee², Yebin Park³, Young Goo Song¹, Kyung Do Han⁴, Sang Hoon Han⁵

Affiliations

¹ Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Department of Preventive Medicine and Public Health, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
³ Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
⁴ Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea. Electronic address: hkd917@naver.com.
⁵ Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: shhan74@yuhs.ac.

PMID: 38704274
DOI: 10.1016/j.jmii.2024.04.009

Abstract

Background: As the group at high risk for sepsis is increasing with the aging of the population, physical activity (PA), which has beneficial effects on various diseases, needs to be considered as a personalized prevention strategy for sepsis without direct anti-sepsis drug.

Purpose: To examine the association between the amount of PA (based on intensity, duration, and frequency) and the incidence rates of sepsis and mortality after sepsis.

Methods: This was a large-scale, retrospective, longitudinal cohort study using data from the Korean National Health Insurance Service and the biennial general health screening program. The amount of PA self-reported at the time of the health screening was categorized as non-PA, mild (<500 metabolic equivalents [METs]-Min/Week), moderate (500-1000), severe (1000-1500), and extreme (≥1500). The multivariable regression model was adjusted for age, sex, income, body mass index, smoking, alcohol consumption, diabetes, hypertension, dyslipidemia, and chronic diseases.

Results: From 4,234,415 individuals who underwent a health screening in 2009, 3,929,165 subjects were selected after exclusion for wash-out period and a 1-year lag period, and then observed for the event of sepsis or all-cause death until December 2020. During a median 10.3 years of follow-up, 83,011 incidents of sepsis were detected. The moderate-PA group showed the lowest incidence (1.56/1000 person-years) and risk for sepsis, with an adjusted hazard ratio (aHR) of 0.73 (95% CI, 0.72-0.75, P < 0.001) compared with the non-PA group. The occurrence of sepsis among people aged ≥65 years and ex-smokers were significantly lower in the moderate-PA group (aHR; 0.77, 95% CI; 0.74-0.79; and 0.68, 0.64-0.71, respectively, Ps < 0.001). The long-term all-cause mortality after sepsis was significantly lower in the PA group than in the non-PA group (overall P = 0.003).

Conclusions: Physical activity is associated with a lower risk of sepsis, especially in elderly people who have the highest incidence of sepsis. The protective effects of aerobic PA on sepsis might need to be incorporated with other interventions in sepsis guidelines through the accumulation of future studies.

Keywords: Exercise; Incidence; Mortality; Physical activity; Sepsis.