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

Abstract

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.

Periodontitis and the subsequent risk of glaucoma: results from the real-world practice

“…In addition, the universal coverage (> 99.9%) in the insurance program ensures that all citizens can have no access barriers to health care, irrespective of socioeconomic factors 30 . The NHIRD allowed us to reflect a “real-world” scenario in which periodontitis, glaucoma, and other comorbidities were diagnosed directly during medical consultation 31 , 32 .…”

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

“…In 2017, the NHIRD included information of 99.6% of Taiwan’s population [ 18 ]. In the NHIRD, diagnostic coding is based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) [ 2 ]. All of the insured individuals’ information was deidentified prior to the release of the data to the researchers to ensure no violation of the patients’ rights and welfare [ 2 , 18 ].…”

“…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

“…In 1995, the Taiwanese government established its NHI program, which is a universal scheme covering medical care for more than 99% of the residents of Taiwan [11]. Because of this near-universal rate of coverage, studies that analyze the data contained in the NHIRD can be regarded as national population-based studies; a wide range of information is included in the NHIRD, such as data concerning clinic visits, prescriptions, surgeries, and other procedures [12]. The NHIRD has been used in various scientific studies, and the information on diagnosis, hospitalization, and prescription use documented in the database has been proved to be of high quality.…”