Short-Term Prognostic Factors in Hospitalized Herpes Zoster Patients and Its Associated Cerebro-Cardiovascular Events: A Nationwide Retrospective Cohort in Japan

Abstract

BackgroundShort-term mortality and incidence of cerebrovascular and cardiovascular events (C-CVE) during hospitalization of patients with severe herpes zoster (HZ) have not been sufficiently investigated. We aimed to investigate short-term prognosis and incidence of C-CVE associated with HZ in hospitalized patients.MethodsThis retrospective cohort study from April 2016 to March 2018 included HZ inpatient cases selected from the Diagnosis Procedure Combination database—a Japanese nationwide inpatient database. HZ and C-CVE were diagnosed based on the 10th revision of the International Classification of Diseases and Injuries codes. The definition of primary exposure was that treatments were initiated within 7 days of admission, and antivirals were administered for ≥7 days. Main Outcomes were in-hospital deaths and C-CVE onset after hospitalization.ResultsAmong 16,811,501 in-hospital cases registered from 1,208 hospitals, 29,054 cases with HZ were enrolled. The median age was 71.0 years, 15,202 cases (52.3%) were female, and the HZ types were the central nervous system (n=9,034), disseminated (n=3,051), and ophthalmicus (n=1,069) types. There were 301 (1.0%) in-hospital deaths and 385 (1.3%) post-hospitalization onset of C-CVE. The 30-day in-hospital survival rates with or without underlying disease were 96.8% and 98.5%, respectively. Age ≥75 years (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.55–3.05), liver cirrhosis or hepatic failure (HR, 5.93; 95% CI, 2.16–16.27), chronic kidney disease (HR, 1.82; 95% CI, 1.24–2.68), heart failure (HR, 1.65; 95% CI, 1.22–2.24), and old cerebrovascular events (HR, 1.92; 95% CI, 1.10–3.34) were associated with poor short-term prognosis. Age ≥75 years (odds ratio [OR], 1.70; 95% CI, 1.29–2.24), diabetes (OR, 1.50; 95% CI, 1.19–1.89), dyslipidemia (OR, 1.95; 95% CI, 1.51–2.51), hyperuricemia (OR, 1.63; 95% CI, 1.18–2.27), hypertension (OR, 1.76; 95% CI, 1.40–2.20), heart failure (OR, 1.84; 95% CI, 1.32–2.55), and glucocorticoid administration (OR, 1.59; 95% CI, 1.25–2.01) were associated with increased risks for in-hospital C-CVE onset.ConclusionsThe underlying diseases that could influence the short-term mortality of severe HZ were identified. Glucocorticoid is a possible risk factor for the in-hospital onset of C-CVE after severe HZ development.

Short-term effectiveness and safety of rituximab versus cyclophosphamide for life-threatening ANCA-associated vasculitis: a propensity score analysis of the real-world nationwide database

“…It was expected that the use of the ICD-10 codes alone would identify patients who did not receive remission induction therapy for life-threatening AAV. To ensure the robustness of the diagnosis, patients who received both systemic GCs and immunosuppressants CY or RTX as an immunosuppressive therapy during hospitalisation were enrolled 20 21. The principal diagnosis of underlying diseases was recorded using the following ICD-10 codes: malignancies, C00–C98; solid cancer, C00–C80 and C97; malignant lymphoma and haematopoietic malignancies, C81–C96; diabetes mellitus (DM), E10–E14; dyslipidaemia, E78; chronic obstructive pulmonary disease, J44; interstitial lung disease, J84, J99.0 and J99.1; hypertension (HT), I10–I15; heart failure (HF), I11.0, I13.0, I50 and I97.1; ischaemic heart disease, I25; cerebrovascular disease (CVD), I69; chronic kidney disease (CKD), N18.…”

A systematic literature review of the epidemiology and burden of herpes zoster in selected locales in Asia Pacific

“…HZ: herpes zoster; HZO: herpes zoster ophthalmicus; PHN: postherpetic neuralgia. Articles included: dermatological/soft tissue infection, 26 , 49 , 69 disseminated HZ, 51 , 54 , 68 , 70 , 71 ear-related/Ramsay-hunt syndrome, 54 , 68 , 71 encephalitis, 51 , 54 , 68 lower respiratory tract infection, 49 meningitis, 51 , 68 , 72 , 73 meningitis encephalitis, 71 neurological, 26 , 51 , 68–70 , 72 ocular/ophthalmic, 26 , 49 , 51 , 54 , 55 , 68–72 , 74–76 PHN, 26 , 27 , 35 , 46 , 47 , 52–54 , 59 , 68–71 , 75 , 77–89 vision loss, 90 , 91 and other. 26 , 51 , 54 , 70 , 72 , 92 .…”

“… 51 , 72 In Hong Kong, similar HZ-related complications were reported in hospitalized HZ cases and those in the Accident and Emergency (A&E) unit, although there was a lower proportion of patients for the latter. 68 Complications reported in hospitalized HZ patients were generally of the following categories: neurological (33.1–35.1% in Australia, 15.9% in Hong Kong), 51 , 68 , 72 ear-related including Ramsay-Hunt syndrome (1.9–3.4% in Hong Kong), 68 , 71 ocular or ophthalmic (16.0–16.2% in Australia, 4.9–6.7% in Hong Kong, 3.7% in Japan, 11.3% in Taiwan), 49 , 51 , 68 , 71 , 72 , 74 meningitis (0.2–0.8% in Australia, 0.5% in Hong Kong), 51 , 68 , 72 encephalitis (1.1% in Australia, 0.2% in Hong Kong), 51 , 68 meningitis encephalitis (1.0% in Hong Kong), 71 and disseminated HZ (1.1% in Australia, 0.6–1.0% in Hong Kong). 51 , 68 , 71 The variability observed in these proportions may be attributed to inconsistent definitions and methods of ascertaining the conditions in patients across the studies.…”

“… 68 , 72 In Japan, 30-day and 60-day survival rates among hospitalized HZ patients were 97.0% and 87.7%, respectively. 74 …”

Herpes Zoster and Cardiovascular Disease: Exploring Associations and Preventive Measures through Vaccination

“…In a large cohort study involving 25,209 patients diagnosed with herpes zoster during the study period, dyslipidemia and prior myocardial infarction were significant risk factors, whereas diabetes mellitus, hypertension, prior stroke, and smoking were not [ 18 ]. In a Japanese cohort study using the Diagnosis Procedure Combination (DPC) database, age ≥ 75 years, diabetes mellitus, dyslipidemia, hyperuricemia, hypertension, heart failure, and glucocorticoid administration were associated with increased risks of herpes zoster onset in patients hospitalized for cerebrovascular and cardiovascular events [ 19 ]. In a Korean nationwide cohort study, comorbidities including hematologic malignancies, hypertension, diabetes mellitus, and chronic lung and liver disease increased the risk of herpes zoster in patients with rheumatic disease [ 20 ].…”