Splenectomy correlates with increased risk of pulmonary tuberculosis: a case–control study in Taiwan

Abstract

This study investigated whether there was an association between splenectomy and pulmonary tuberculosis. This was a case-control study using the database of the Taiwan National Health Insurance Programme. We identified 18 960 patients (aged 20 years or older) with newly diagnosed pulmonary tuberculosis as the case group and 73 988 participants without pulmonary tuberculosis as the control group from 1998 to 2011. Both groups were matched for sex, age (per 5 years) and index year of pulmonary tuberculosis diagnosis. The risk of pulmonary tuberculosis associated with splenectomy and other co-morbidities was estimated. After controlling for confounders, multivariable logistic regression analysis showed that the odds of pulmonary tuberculosis were 1.91 in patients with splenectomy (95% CI 1.06-3.44), compared with the participants without splenectomy. Chronic obstructive pulmonary diseases (OR 3.07, 95% CI 2.94-3.21), pneumoconiosis (OR 2.20, 95% CI 1.90-2.56), chronic kidney diseases (OR 1.49, 95% CI 1.33-1.67), diabetes mellitus (OR 1.57, 95% CI 1.50-1.64) and chronic liver diseases (OR 1.31, 95% CI 1.25-1.37) were associated with an increased risk of pulmonary tuberculosis. The sub-analysis demonstrated that the odds of pulmonary tuberculosis were 4.81 (95% CI 2.31-10.0) for patients co-morbid with splenectomy and any of the above diseases. Splenectomy is associated with a 1.9-fold increased risk of pulmonary tuberculosis in Taiwan. There is a synergistic effect between splenectomy and other co-morbidities on the risk of pulmonary tuberculosis.

Splenectomy Correlates With Increased Risk of Acute Pancreatitis: A Case-Control Study in Taiwan

“…1 , 2 After splenectomy, the impaired immune functions place subjects at high risk for overwhelming postsplenectomy infections. 1 – 6 Therefore, the pancreas might be easily infected by the offending microorganisms, subsequently leading to pancreatic inflammation. Splenectomy has also been found to be associated with an increased risk of type 2 diabetes mellitus, 22 and patients with type 2 diabetes mellitus are at an elevated risk of acute pancreatitis.…”

“…Specifically, the spleen protects against infections mediated by innate and adaptive immunity. 1 , 2 Further, in persons with splenectomy, there is growing evidence of serious post-splenectomy complications, including atelectasis, pulmonary embolism and bleeding in the early period, and pulmonary tuberculosis and overwhelming postsplenectomy infections in the late period 1 – 6 ; however, acute pancreatitis has not been well studied.…”

Correlation of Proton Pump Inhibitors with Pulmonary Tuberculosis: A Case-Control Study in Taiwan

“…All comorbidities were diagnosed with ICD-9 codes. The accuracy of these codes has been examined in previous studies (Lai et al, 2013a,b, 2014a,b, 2017; Hung et al, 2016; Lai, 2016; Lin et al, 2016a, 2016b; Shen et al, 2016; Hsu et al, 2017; Liao et al, 2017a,b). …”

Trends in pediatric spleen management

“…As such, we included receipt of blood products as a potential surrogate for hypotension. We created control indicator variables as follows: patient transferred in from another hospital (coded 1 if transferred in, 0 if not transferred in), receipt of blood products (ICD-9-CM procedure codes 99.00Y99.09), presence of massive spleen disruption (ICD-9-CM 865.04, 865.14), and presence of other abdominal injuries (ICD-9-CM 86 (3,4,6,8). Hospital characteristics such as teaching status, hospital location (rural vs. urban), and hospital bed size (small, medium, and large) were also included as control variables.…”

“…3,5,6 In addition, splenectomy also increases risk for short-term hematologic complications and long-term cardiovascular complications. 7,8 Conversely, nonoperative management (NOM) of blunt splenic injury allows for spleen preservation and functioning and is estimated successful in 90% of cases. 9 Advantages of NOM include fewer blood transfusions, shorter hospital stays, lower hospital charges, lower OPSI risk, and lower mortality compared with performing splenectomy in children.…”