End-stage renal disease: a risk factor of deep neck infection – a nationwide follow-up study in Taiwan

Abstract

BackgroundUremia is likely a risk factor for deep neck infection (DNI). However, only a few relevant cases have been reported, and evidence sufficient to support this hypothesis is lacking. The aim of the study is to investigate the effects of end-stage renal disease (ESRD) on DNI.MethodsWe used the database of the Registry for Catastrophic Illness Patients (RFCIP), a subset of the National Health Insurance Research Database (NHIRD) in Taiwan, to conduct a retrospective follow-up study. Between 1997 and 2013, a total of 157,340 patients in Taiwan with ESRD who received dialysis were registered in the RFCIP, whom were matched with a database consisting of 1,000,000 randomly selected patients who represented the national population, to conduct the follow-up study for investigating the incidence of DNI in the ESRD and control cohorts.ResultsIn the ESRD group, 280 DNIs were identified with an incidence rate of 43 per 100,000 person-years. In the comparison group, 194 DNIs were identified with an incidence rate of 20 per 100,000 person-years. The incidence rate ratio was 2.16 (p < 0.001). Kaplan–Meier analysis indicated that the ESRD group had a significantly higher cumulative incidence of DNI (p < 0.001). According to Cox regression analysis, the hazard ratio of ESRD for DNI was 2.23 (p < 0.001). The therapeutic methods (non-surgery and surgery), performance of tracheostomy, duration of hospitalization did not differ significantly between the two groups, except more ESRD-DNI patients were admitted to intensive care units. The mortality rate of patients with DNI in the ESRD group was significantly higher than that in the control group (8.6% for ESRD vs 3.6% for control, p = 0.032). Furthermore, the Kaplan–Meier analysis demonstrated a poorer survival outcome in the ESRD group (p = 0.029). However, the individual survival outcomes following non-surgical and surgical therapies in the ESRD group did not differ significantly (p = 0.31).ConclusionsESRD is a predisposing factor for DNI, increasing its risk by twofold. In the patients with ESRD, DNI was not associated with higher rates of surgical debridement, tracheostomy, and mediastinal complications or longer hospital stays; however, it was associated with poorer survival outcomes, regardless of the therapeutic method.

Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages

“…Deep neck infections Higher than in GP*, especially in patients on HD [51,[54][55][56] 3-times higher risk of serious infection in CKD on HD than in GP [54] Need for hospitalization because of serious DNI is almost 10-times higher in CKD on HD than in GP [54] Predisposing mechanisms prognosis than non-CKD individuals when treated with systemic glucocorticosteroids, a first-line treatment for SSNHL [12]. In contrast to that, promising results in SSNHL treatment in patients with CKD were accomplished by intratympanic steroid injections [12].…”

“…It was implied that CKD predisposes to DNIs, a polymicrobial, rapidly progressing and life-threatening disease [51].…”

“…DNIs require aggressive and immediate treatment because of the life-threatening nature of the disease [52]. The prognosis of successful DNI treatment in patients with CKD, especially in RTRs, is worse than in general population [51]. Reoperations and longer hospitalizations are often required in these patients [53].…”

“…Studies presented that individuals with CKD, especially those on dialysis, were more prone to develop DNIs [51,[54][55][56]. Additionally, CKD predisposed to the extension of DNI into the mediastinal space [57].…”

“…According to studies, the most important factor predisposing to DNIs in CKD population is uremia, however, this hypothesis lacks strong evidence based on large cohort studies [51,54].…”