The Association Between Decompensated Liver Cirrhosis and Deep Neck Infection: Real-World Evidence

Abstract

Background: Deep neck infection (DNI) can progress to become a life-threatening complication. Liver cirrhosis, which is related to poor immune conditions, is a likely risk factor for DNI. This study investigated the risk and mortality of DNI in patients with decompensated liver cirrhosis (DLC). Methods: We performed a nationwide cohort study using the National Health Insurance Research Database (NHIRD) in Taiwan. We included a total of 33,175 patients with DLC between 2000 and 2013, from the Catastrophic Illness Patient Database, a subsection of the NHIRD, along with 33,175 patients without cirrhosis who were matched in a 1:1 proportion for age, sex, and socioeconomic status. The occurrence of DNI was the primary study outcome. The risk, treatment, and mortalities of DNI were evaluated in the study and comparison cohorts. Results: DLC Patients had a significantly higher incidence of DNI than noncirrhotic patients (p < 0.001). The adjusted Cox proportional hazard regression showed that DLC was associated with a significantly higher risk of DNI (adjusted hazard ratio, 4.11; 95% confidence interval, 3.16–5.35, p < 0.001). The mortality rate in cirrhotic patients with DNI was not significantly higher than that in noncirrhotic patients with DNI (11.6% vs. 9.8%; p = 0.651). Conclusions: This study is the first to investigate the correlation between DLC and DNI. The study findings strongly indicate that DLC is an independent risk factor for DNI. Cirrhotic patients with DNI do not have a significantly poorer survival rate than noncirrhotic patients with DNI. Therefore, physicians should be alert to potential DNI occurrence in DLC patients. Besides this, intensive care and appropriate surgical drainage can yield similar survival outcomes in DLC-DNI and noncirrhosis-DNI patients.

Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence

“…Our primary outcome was DNI incidence, which was defined as hospitalization with one of the following diagnoses: Peritonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, cellulitis and abscess of oral soft tissues (Ludwig’s angina), and cellulitis and abscess of the neck (ICD-9-CM 475, 478.22, 478.24, 528.3, and 682.1) [ 3 ]. Patients in both cohorts were followed-up until DNI occurrence, mortality, or the end of 2013.…”

“…DNIs may also invade adjacent organs and structures, such as the brain, spine, and mediastinum, or spread throughout the body to cause sepsis. According to the literature, once DNI has spread to the mediastinum in a patient with diabetes or an immune-related disease, the mortality rate may be as high as 50% [ 1 , 2 , 3 , 4 , 5 ]. Compared with non-immunocompromised patients, immunocompromised patients, including those with decompensated liver cirrhosis (LC), systemic lupus erythematous, and diabetes mellitus (DM), have been reported to be more likely to develop DNI without the typical symptoms, which may lead to more severe complications and a higher likelihood of mortality [ 1 , 3 , 4 , 5 ].…”

Allergic Rhinitis and Laryngeal Pathology: Real-World Evidence

“…[13,14] Diagnosis codes in the NHIRD are those of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and the procedure codes are those of the International Classification of Diseases, Ninth Revision, Procedure Coding System [15]. For research purposes, the National Health Research Institutes (NHRI) of Taiwan makes available the Longitudinal Health Insurance Database 2000 (LHID2000), which holds the records of one million individuals arbitrarily selected through systematic sampling from among all NHIRD registrants enrolled in the year 2000 and all claims data recorded from 1996 to 2013 [16,17]; our study data were obtained from this database. According to the NHRI, the LHID2000 sample and all NHI enrollees do not significantly differ with respect to age, sex, or socioeconomic status [18].…”

Innovative continuous-irrigation approach for wound care after deep neck infection surgery: A case report

“…Deep neck infection is a dangerous and life-threatening disease that invades deep neck space and potentially causes airway obstruction [ 1 , 2 ]. Treatment for deep neck infection mainly consists of antibiotic administration and surgical drainage with postoperative wound irrigation [ 3 ]. Postoperative irrigation should be performed every 4–8 hours by doctors according to disease severity, which imposes additional physical and time-related burdens on medical staff [ [4] , [5] , [6] ].…”