High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study

Chang, Geng‐He; Ding, Meng-Chang; Yang, Ya‐Chen; Lin, Yung-Hsiang; Liu, Chia‐Yen; Lin, Meng‐Hung; Wu, Ching‐Yuan; Hsu, Cheng‐Ming; Tsai, Ming‐Shao

doi:10.3390/jcm7110385

Cited by 20 publications

(43 citation statements)

References 31 publications

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“…Based on the preceding evidence, the aforementioned factors could constitute the etiologies for the higher incidence of DNI in SLE patients. Surgical debridement accounts for 20-80% of all therapies for DNI 1,3,4,[30][31][32][33][34] . In our study, 15.6% of SLE-DNI patients and 28.6% of non-SLE-DNI patients received surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…NHIRD lists SLE under the "catastrophic illness" category. The Taiwanese government certifies SLE patients through a process that entails closely assessing medical records in addition to pathological and serological reports supplied by medical professionals 1,3 . Subsequently, the patients are included in the Registry for Catastrophic Illness Patients (RFCIP) and are entitled to substantial discounts on medical expenses.…”

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confidence: 99%

“…From the Longitudinal Health Insurance Database 2000 (LHID2000), which is an NHIRD subset consisting of data of 1,000,000 insurance beneficiaries randomly selected from all beneficiaries in 2000, we collected data to establish our comparison cohort 15,17 . The National Health Research Institutes has published reports 1,3,15 revealing no significant disparity in healthcare costs or sex or age distribution between the sample group derived from LHID2000 and all beneficiaries in the NHIRD. Several population-based studies have employed LHID2000 1,3,12-15 .…”

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confidence: 99%

“…Comorbidities. Several diseases that can lead to an immunocompromised status can be DNI risk factors; these include chronic kidney disease (CKD), DM, and liver cirrhosis (LC) 1,3,4,18 . In addition, tonsillectomy is confirmed a DNI risk factor 19 .…”

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confidence: 99%

“…We subcategorized our included patients into the following groups according to the therapeutic modalities applied to them: "surgical" group, comprising patients undergoing surgical intervention; and "nonsurgical" group, comprising patients receiving antibiotic or abscess aspiration without surgery 1,3 . prognosis evaluation. We analysed prognosis using the hospitalisation duration, intensive care unit (ICU) admission, tracheostomy performance, and mediastinal complications-all defined in accordance with ICD-9-CM codes for mediastinitis (510, 513, and 519.2) or on the basis of whether patients received mediastinal surgery during hospitalisation 1,3 . For both cohorts, we investigated mortality (death in the course of DNI treatment) and mortality related to mediastinitis (death in the course of DNI treatment along with a mediastinitis diagnosis) 1,3 . Association of DNI occurrence with steroid dose for SLE therapy.…”

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confidence: 99%

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Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Chang

Lin

et al. 2020

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Systemic lupus erythematosus (SLE) might increase deep neck infection (DNI) risk, but evidencesupporting this hypothesis is limited. In this retrospective follow-up study, the SLE-DNI association was investigated using data from the Registry for Catastrophic Illness Patients, which is a subset of the Taiwan National Health Insurance Research Database. All patients newly diagnosed as having SLE in 1997-2011 were identified, and every SLE patient was individually matched to four patients without SLE according to sex, age, and socioeconomic status. The study outcome was DNI occurrence. DNI treatment modalities and prognoses in SLE and non-SLE patients, along with the association of steroid dose with DNI risk, were also studied. In total, 17,426 SLE and 69,704 non-SLE patients were enrolled. Cumulative DNI incidence was significantly higher in the SLE cohort than in the non-SLE cohort (p < 0.001). The Cox regression model demonstrated that SLE significantly increased DNI risk (hazard ratio: 4.70; 95% confidence interval: 3.50-6.32, p < 0.001). Moreover, in the sensitivity and subgroup analyses, the effect of SLE on DNI was stable. Relatively few SLE-DNI patients received surgical interventions (15.6% vs. 28.6%, p = 0.033). The between-group differences in tracheostomy use and hospitalisation duration were nonsignificant. In SLE patients, high steroid doses significantly increased Dni incidence (≥3 vs. <3 mg/day = 2.21% vs. 0.52%, p < 0.001). This is the first study demonstrating that SLE increases DNI risk by approximately five times and that high steroid dose increases DNI incidence in SLe patients. The prevalent infectious disease deep neck infection (DNI) is typically encountered in emergency departments.Patients with DNI typically require intensive care and aggressive treatment. DNI has the likelihood to be life threatening, notably in systemic disease patients and elderly individuals 1-3 . Immunocompromised patients do not show usual symptoms of DNI, making its early diagnosis difficult, possibly increasing complications and mortality 1,3-5 . Therefore, investigating the influence of immunosuppressing diseases on DNI is important.Systemic lupus erythematosus (SLE) renders its affected patients vulnerable to infection; in addition, in such patients undergoing dialysis, infection is a notable cause of mortality 6-9 . SLE activity itself and long-term usage of immunosuppressants are considered the two main causes for infection susceptibility 6,10 . In their case series of 130 patients with DNI, Yang et al. 11 reported two cases of DNI in patients with SLE under steroid therapy. However, the influence of SLE on DNI was not investigated in depth. In addition, the association between the duration of SLE, steroid dosage, and DNI risk remains unknown. We therefore conducted this real-world study with the primary purpose of probing the influence exerted by SLE on DNI incidence, treatment, and prognosis.

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Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Chang

Lin

et al. 2020

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Real‐world evidence for increased deep neck infection risk in patients with rheumatoid arthritis

et al. 2019

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Objective To investigate the association between rheumatoid arthritis (RA) and deep neck infection (DNI). Study Design Retrospective cohort study. Methods Patients newly diagnosed with RA between 2000 and 2011 were identified from the National Health Insurance Research Database in Taiwan. Moreover, patients without RA were randomly selected and matched at a 1:4 ratio by age, sex, urbanization level, income, and diabetes mellitus. The patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of DNI. Results In total, 30,207 patients with RA and 120,828 matched patients without RA were enrolled. Patients with RA had a significantly higher cumulative incidence of DNI than those without RA (P < 0.001). The adjusted Cox proportional hazard model demonstrated that RA was significantly associated with a higher incidence of DNI (hazard ratio: 2.80, 95% confidence interval: 2.26–3.46, P < 0.001). Therapeutic methods (surgical or nonsurgical) did not differ significantly between the patients with RA‐DNI and with non–RA‐DNI. Patients with RA‐DNI had higher rates of tracheostomy, mediastinitis, mediastinitis‐related mortality, and mortality than patients with non–RA‐DNI, although these differences were without statistical significance. RA patients receiving no therapy experienced higher rates of DNI compared with those receiving methotrexate alone, disease‐modifying antirheumatic drugs, or biologic therapies. Conclusion This study is the first to investigate the association between RA and DNI. We conclude RA is an independent predisposing factor for DNI. Level of Evidence 4 Laryngoscope, 130:1402–1407, 2020

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Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence

Tsai

Huang

et al. 2020

The Laryngoscope

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ObjectiveTo assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence.Study DesignRetrospective cohort study.MethodsPatients newly diagnosed with OSA during 1997–2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence.ResultsThis study included 3,978 OSA patients and 15,912 non‐OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval [CI], 1.27–3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06–0.98).ConclusionOSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development.Level of EvidenceIV Laryngoscope, 130:2292–2298, 2020

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High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study

Cited by 20 publications

References 31 publications

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Real‐world evidence for increased deep neck infection risk in patients with rheumatoid arthritis

Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence

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