Could celiac disease increase infection risk after sepsis, and how should it be monitored?

Yes, celiac disease raises the risk of certain infections, and the monitoring that matters is gut-focused and immune-focused, not sepsis-specific.

Celiac patients get more Clostridium difficile infection, about twice the rate of matched controls, and the excess is highest in the first year after diagnosis [1]. They also get more pneumococcal infection: pooled across three cohorts the odds were about 1.7 times higher, and in Swedish patients aged 16 and up the hazard was 2.8 [2]. The mechanism is partly a spleen that works poorly (hyposplenism), which is why pneumococcal risk climbs [3].

What this evidence does not show is anything specific to post-sepsis recovery in celiac patients. The sepsis literature here is about survivors in general, not celiac survivors [5]. So the monitoring advice is inference, not trial data.

Practical monitoring: keep the gluten-free diet strict, because active disease and gluten exposure track with worse immune response [3]. Check hepatitis B antibody titers, since seroconversion is often poor and improves on a gluten-free diet with boosters [3]. Check serum zinc, low in up to about two-thirds of newly diagnosed celiac patients and not always fixed by diet alone [4]. Ask whether the spleen is working, because that drives the pneumococcal risk [3]. Watch for C. difficile in the first year, especially after antibiotics [1].

My call: treat the celiac as an active immune and gut problem during recovery, not a background label, and monitor gluten adherence, B and pneumococcal status, zinc, and C. difficile risk. Confidence: moderate that celiac raises infection risk generally, low that any of this changes post-sepsis outcomes specifically, because that comparison has not been run in these records.