BackgroundInfections may play a role in the development of systemic lupus erythematosus (SLE).ObjectiveTo assess the link between Mycoplasma pneumonia (M. pneumonia) infection and the incidence of SLE.MethodWe conducted a retrospective cohort study, which identified 116,043 hospitalized patients with M. pneumoniae between 2000 and 2012 from the Taiwan National Health Insurance Research Database and compared them with 447,839 matched inpatients who had never been diagnosed with M. pneumonia infection (at a 1:4 ratio, matched by age, gender, and index year). Their comparative risk of developing SLE was evaluated. The follow-up period was defined as the time from the initial diagnosis of M. pneumonia infection to the date of SLE diagnosis, or December 31, 2013. The incidence rates of SLE were assessed in people with and without M. pneumoniae infection. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), with the uninfected group used as the reference.ResultsThe adjusted HR of SLE for the M. pneumoniae group was 2.97 with 95% CI = 2.18–4.05 compared with the uninfected group. The risk was most significantly higher within 0.5 years after the M. pneumoniae infection with an adjusted HR of 6.18 (95% CI = 3.82–9.97, p < 0.01). The adjusted HR for SLE from 0.5 to 2 years and from 2 to 5 years after M. pneumoniae infection was 1.59 (95% CI = 0.70–3.59, p = 0.27) and 2.42 (95% CI = 1.22–4.81, p = 0.01), respectively.ConclusionThe incidence of SLE was significantly higher in subjects infected with M. pneumoniae.
Background and Purpose Stroke is a rare complication of snakebites, but may lead to serious sequelae. We aimed to explore the relationship between venomous snakebite and the risk for acute stroke, in a nationwide population-based cohort study. Methods This retrospective cohort study used claims data between January 1, 2000 and December 31, 2012, from the Taiwan National Health Insurance Research Database. The study included data of patients aged 18 years or older with venomous snakebite (N = 535), matched for propensity score with controls without venomous snakebite (N = 2140). The follow-up period was the duration from the initial diagnosis of venomous snakebite and administration of antivenom to the date of an acute stroke, or until December 31, 2013. The competing risk model was used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of stroke, ischemic stroke, and hemorrhagic stroke, after adjusting for demographic and other possible stroke risk factors. Result The adjusted HR for the venomous snakebite group compared with the control group was 2.72 for hemorrhagic stroke (95% CI: 1.41, 5.26). Stratified analysis showed that the older age group (>65 years old) had a higher risk of hemorrhagic stroke. A 2.68-fold significant increase in the risk for hemorrhagic stroke was observed following venomous snakebite with antivenom usage (95% CI = 1.46, 26.63). Conclusion Venomous snakebite is associated with an increased risk of hemorrhagic stroke after the use of an antivenom. Further study of the underlying mechanism is warranted.
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