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

(1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide retrospective cohort study on the sleep apnea–DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort (p < 0.001). A strong sleep apnea–DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28–2.28; p < 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged < 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.

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High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm7110385 ◽

2018 ◽

Vol 7 (11) ◽

pp. 385 ◽

Cited By ~ 8

Author(s):

Geng-He Chang ◽

Meng-Chang Ding ◽

Yao-Hsu Yang ◽

Yung-Hsiang Lin ◽

Chia-Yen Liu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Cohort Study ◽

Type 1 Diabetes Mellitus ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Deep Neck Infection ◽

Research Database ◽

Neck Infection

Objective: To investigate the risk of deep neck infection (DNI) in patients with type 1 diabetes mellitus (T1DM). Methods: The database of the Registry for Catastrophic Illness Patients, affiliated to the Taiwan National Health Insurance Research Database, was used to conduct a retrospective cohort study. In total, 5741 patients with T1DM and 22,964 matched patients without diabetes mellitus (DM) were enrolled between 2000 and 2010. The patients were followed up until death or the end of the study period (31 December 2013). The primary outcome was the occurrence of DNI. Results: Patients with T1DM exhibited a significantly higher cumulative incidence of DNI than did those without DM (p < 0.001). The Cox proportional hazards model showed that T1DM was significantly associated with a higher incidence of DNI (adjusted hazard ratio, 10.71; 95% confidence interval, 6.02–19.05; p < 0.001). The sensitivity test and subgroup analysis revealed a stable effect of T1DM on DNI risk. The therapeutic methods (surgical or nonsurgical) did not differ significantly between the T1DM and non-DM cohorts. Patients with T1DM required significantly longer hospitalization for DNI than did those without DM (9.0 ± 6.2 vs. 4.1 ± 2.0 days, p < 0.001). Furthermore, the patients with T1DM were predisposed to DNI at a younger age than were those without DM. Conclusions: T1DM is an independent risk factor for DNI and is associated with a 10-fold increase in DNI risk. The patients with T1DM require longer hospitalizations for DNI and are younger than those without DM.

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Is depression a risk factor for mortality in chronic hemodialysis patients?

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462008000200003 ◽

2008 ◽

Vol 30 (2) ◽

pp. 99-103 ◽

Cited By ~ 26

Author(s):

Edgar C Diefenthaeler ◽

Mário Bernardes Wagner ◽

Carlos Eduardo Poli-de-Figueiredo ◽

Paulo R Zimmermann ◽

David Saitovitch

Keyword(s):

Risk Factor ◽

Beck Depression Inventory ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Depressive Symptomatology ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Chronic Hemodialysis ◽

Cox Proportional Hazards Model ◽

Hazards Model

OBJECTIVE: The present study was conducted to assess the association between depressive symptomatology and mortality in chronic hemodialysis. METHOD: A cohort of 40 patients was followed for a median period of 10.5 months. The Beck Depression Inventory was used to classify patients as exposed to depression (Beck Depression Inventory score > 14) or not (Beck Depression Inventory < 14). Kaplan-Meier survival curves were used to compare the mortality rate between the two groups. The effects of potential confounding factors were adjusted using Cox proportional hazards model. RESULTS: After 24 months of follow-up, survival rates were 39% for exposed and 95% for non-exposed patients (p = 0.029). The Cox proportional hazards model showed results similar to those of the bivariate analysis, indicating that depressive symptomatology tended to be associated with mortality (HR = 6.5, 95%CI: 0.8-55.6; p = 0.085). Other study variables, including age, concurrent systemic diseases, and biochemical markers, were not significantly associated with mortality. Exposed patients remained on dialysis longer and received kidney transplants less frequently (9% vs. 50% for non-exposed patients). When kidney transplantation was included in the Cox regression model, the hazard ratio of mortality for exposed as compared to non-exposed patients lost statistical significance (HR = 4.5; 95%CI: 0.5-40.0; p = 0.17). CONCLUSIONS: Our study suggests that the presence of depressive symptoms may act as an independent risk factor for mortality in chronic hemodialysis patients. However, this finding needs further investigations.

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Hyperlipidemia and Statins Use for the Risk of New Diagnosed Sarcopenia in Patients with Chronic Kidney: A Population-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17051494 ◽

2020 ◽

Vol 17 (5) ◽

pp. 1494 ◽

Cited By ~ 2

Author(s):

Min-Hua Lin ◽

She-Yu Chiu ◽

Pei-Hsuan Chang ◽

Yu-Liang Lai ◽

Pau-Chung Chen ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Population Based ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Research Database ◽

Newly Diagnosed ◽

Hazards Model

Background: Previous research found that statins, in addition to its efficiency in treating hyperlipidemia, may also incur adverse drug reactions, which mainly include myopathies and abnormalities in liver function. Aim: This study aims to assess the risk for newly onset sarcopenia among patients with chronic kidney disease using statins. Material and Method: In a nationwide retrospective population-based cohort study, 75,637 clinically confirmed cases of chronic kidney disease between 1997 and 2011were selected from the National Health Insurance Research Database of Taiwan. The selection of the chronic kidney disease cohort included a discharge diagnosis with chronic kidney disease or more than 3 outpatient visits with the diagnosis of chronic kidney disease found within 1 year. After consideration of patient exclusions, we finally got a total number of 67,001 cases of chronic kidney disease in the study. The Cox proportional hazards model was used to perform preliminary analysis on the effect of statins usage on the occurrence of newly diagnosed sarcopenia; the Cox proportional hazards model with time-dependent covariates was conducted to take into consideration the individual temporal differences in medication usage, and calculated the hazard ratio (HR) and 95% confidence interval after controlling for gender, age, income, and urbanization. Results: Our main findings indicated that patients with chronic kidney disease who use statins seem to effectively prevent patients from occurrences of sarcopenia, high dosage of statins seem to show more significant protective effects, and the results are similar over long-term follow-up. In addition, the risk for newly diagnosed sarcopenia among patients with lipophilic statins treatment was lower than that among patients with hydrophilic statins treatment. Conclusion: It seems that patients with chronic kidney disease could receive statin treatment to reduce the occurrence of newly diagnosed sarcopenia. Additionally, a higher dosage of statins could reduce the incidence of newly diagnosed sarcopenia in patients with chronic kidney disease.

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Osteoporosis and Stress Urinary Incontinence in Women: A National Health Insurance Database Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124449 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4449

Author(s):

Ming-Cheng Wei ◽

Ying-Hsiang Chou ◽

Yi-Sun Yang ◽

Edy Kornelius ◽

Yu-Hsun Wang ◽

...

Keyword(s):

Urinary Incontinence ◽

Health Insurance ◽

Stress Urinary Incontinence ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Newly Diagnosed ◽

Increased Risk ◽

Health Insurance Database ◽

Insurance Database

We aimed to determine the influence of osteoporosis and stress urinary incontinence in women. We hypothesized that women with osteoporosis had an increased risk of stress urinary incontinence. This retrospective study used data from the Taiwan Longitudinal Health Insurance database from 2005–2009. The study population was screened to identify women (age ≥ 40 years) newly diagnosed with osteoporosis (ICD-9-CM code = 733.0, 733.1). The osteoporosis cohort included 6125, and the non-osteoporosis cohort included 12,250 participants. The newly diagnosed stress urinary incontinence incidence was calculated to determine the influence of osteoporosis and stress urinary incontinence. We used the Cox proportional hazards model to predict the effects of stress urinary incontinence and the Kaplan–Meier analysis to estimate the cumulative incidence of stress urinary incontinence in women. Participants with osteoporosis experienced a 1.79 times higher risk than that of the non-osteoporosis group (95% CI = 1.28–2.51) for stress urinary incontinence, regardless of age. We did not observe a higher risk of stress urinary incontinence in participants with pathological fractures compared to those with simple osteoporosis. Our data emphasized that physicians and nurses should conduct urinary incontinence screening in women with osteoporosis to recommend proper treatment, medical help or to bring the disorder to light.

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Risk of pleural empyema in patients with schizophrenia: a nationwide propensity-matched cohort study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2017-021187 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021187 ◽

Cited By ~ 5

Author(s):

Te-Chun Shen ◽

Chia-Hung Chen ◽

Yu-Jhen Huang ◽

Cheng-Li Lin ◽

Ting-Chang Chang ◽

...

Keyword(s):

Cohort Study ◽

Propensity Scores ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Pleural Empyema ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Research Database ◽

Increased Risk ◽

Comparison Cohort

ObjectiveThoracic infection and pneumonia are prevalent in patients with schizophrenia; however, it is unclear whether patients with schizophrenia are at an increased risk of developing pleural empyema.DesignA retrospective cohort study with propensity-matched cohorts with and without schizophrenia.SettingUsing the National Health Insurance Research Database of Taiwan.ParticipantsWe identified 55 888 patients with schizophrenia newly diagnosed in 2000–2011 and same number of individuals without schizophrenia as the comparison cohort, frequency matched by propensity scores estimated using age, sex, occupation, income, urbanisation, year of diagnosis and comorbidities.Primary outcome measuresWe assessed incident pleural empyema by the end of 2011 and used the Cox proportional hazards model to calculate the schizophrenia cohort to comparison cohort HR of pleural empyema.ResultsThe overall incidence of pleural empyema was 2.44-fold greater in the schizophrenia cohort than in the comparison cohort (4.39vs1.80 per 10 000 person-years), with an adjusted HR of 2.87(95% CI 2.14 to 3.84). Stratified analyses by age, sex, occupation, income, urbanisation and comorbidity revealed significant hazards for pleural empyema associated with schizophrenia in all subgroups.ConclusionsPatients with schizophrenia are at an increased risk of developing pleural empyema and require greater attention and appropriate support.

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A lower maximum bite force is a risk factor for developing cardiovascular disease: the Suita study

Scientific Reports ◽

10.1038/s41598-021-87252-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sakae Hashimoto ◽

Takayuki Kosaka ◽

Michikazu Nakai ◽

Momoyo Kida ◽

Shuri Fushida ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Bite Force ◽

Cox Proportional Hazards Model ◽

Trend Test ◽

Quantitative Index ◽

Masticatory Function

AbstractDecreases in masticatory function are believed to be related to the development of cardiovascular disease (CVD) through inappropriate nutritional intake. This study focused on maximum bite force (MBF), which is an objective, quantitative index of masticatory function, and its association with the development of CVD (stroke and coronary heart disease) was investigated. The subjects were 1547 participants of the Suita study with no history of CVD who underwent medical and dental health examinations between June 2008 and June 2013. In addition to undergoing a basic physical examination at baseline, their MBF was measured. They subsequently underwent follow-up surveys for the development of CVD (mean follow-up, 3.5 years). The association between baseline MBF and the development of CVD was investigated by multivariate adjustment using a Cox proportional hazards model. CVD developed in 32 subjects during follow-up. The trend test showed a significant association between baseline MBF and CVD in a model that combined men and women. When analysed by sex, the trend test found a significant association between baseline MBF and CVD in women. Low MBF, which is an objective and quantitative index of masticatory function, may be a risk factor for the development of CVD.

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Occupation as a risk factor for progression of chronic kidney disease: retrospective cohort study

10.1101/2021.03.28.21254487 ◽

2021 ◽

Author(s):

Daisuke Takada ◽

Susumu Kunisawa ◽

Akira Kikuno ◽

Tomoko Iritani ◽

Yuichi Imanaka

Keyword(s):

Chronic Kidney Disease ◽

Health Insurance ◽

Kidney Disease ◽

Primary Outcome ◽

Proportional Hazards Model ◽

Kidney Diseases ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Ckd Progression ◽

Health Checkup

Background Several social determinants of health are associated with the progression of chronic kidney disease (CKD). We compared the risk of CKD progression among 18 occupational classifications using an annual health-checkup database. Methods We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto prefecture between April 2012 and March 2016. The primary outcome for survival analysis was defined as a more than 30% change in the estimated glomerular filtration rate (eGFR) from the first health checkup. We used the Cox proportional-hazards model for time-to-event analyses to estimate the hazard ratio, and 95% CIs for the primary outcome, adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup. Results We analyzed 239,506 employees, and 1,736 (0.7%) individuals whose eGFR had decreased by 30% or more; the mean follow-up period was 2.8 years (standard deviation: 1.2 years). When we compared the risk for manufacturing, five categories of industries (information and communications; transport and postal services; accommodations, eating and drinking services; living-related and personal services and amusement service; medical, health care and welfare) were associated with a decline in the risk of eGFR after adjusting for the confounding factors and/or mediators. Conclusions We provided evidence that the risk of CKD progression depends on occupation type. Further research is needed to confirm the mechanism and causal relationships involved.

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Recurrent Vascular Access Dysfunction as a Novel Marker of Cardiovascular Outcome and Mortality in Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000448058 ◽

2016 ◽

Vol 44 (1) ◽

pp. 71-80 ◽

Cited By ~ 2

Author(s):

Hyo Jin Kim ◽

Hajeong Lee ◽

Dong Ki Kim ◽

Kook-Hwan Oh ◽

Yon Su Kim ◽

...

Keyword(s):

Risk Factor ◽

Propensity Score ◽

Vascular Access ◽

Independent Risk Factor ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

De Novo ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Patients Âgés

Background: Vascular access (VA) is essential for hemodialysis (HD) patients, and its dysfunction is a major complication. However, little is known about outcomes in patients with recurrent VA dysfunction. We explored the influence of recurrent VA dysfunction on cardiovascular (CV) events, death and VA abandonment. Methods: This is a single-center, retrospective study conducted in patients who underwent VA surgery between 2009 and 2014. VA dysfunction was defined as VA stenosis or thrombosis requiring intervention after the first successful cannulation. Patients with ≥2 interventions within 180 days were categorized as having recurrent VA dysfunction. Outcomes were analyzed using Cox proportional hazards model before and after propensity score matching. Results: Of 766 patients (ages 59.6 ± 14.3 years, 59.7% male), 10.1% were in the recurrent VA dysfunction group. Most baseline parameters after matching were similar between the recurrent and non-recurrent groups. A total of 213 propensity score-matched patients were followed for 28.7 ± 15.8 months, during which 46 (21.6%), 30 (14.1%) and 14 (6.6%) patients had de novo CV outcomes, died and abandoned VA, respectively. Recurrent VA dysfunction after adjustment remained an independent risk factor for CV events (adjusted hazards ratio (aHR), 2.71; 95% CI 1.48-4.98; p = 0.001). Moreover, recurrent VA dysfunction predicted composite all-cause mortality (ACM)/CV events (aHR 1.99; 95% CI 1.21-3.28; p = 0.007). Conclusions: Recurrent VA dysfunction was a novel independent risk factor for CV and composite ACM/CV events in HD patients, but not for VA abandonment. Patients with recurrent vascular dysfunction should be carefully monitored not only for VA patency but also for CV events.

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Prefrontal Aβ pathology influencing the pathway from apathy to cognitive decline in non-dementia elderly

Translational Psychiatry ◽

10.1038/s41398-021-01653-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lin Sun ◽

Wei Li ◽

Guanjun Li ◽

Shifu Xiao ◽

Keyword(s):

Risk Factor ◽

Cognitive Decline ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Life Quality ◽

Amyloid Β ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Mediation Effects ◽

Hazards Model

AbstractThe purpose of this study is to investigate the complex connection between apathy and cognitive decline that remains unclear. A total of 1057 non-dementia elderly from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database received up to 13 years of follow-up and were divided into an apathy negative (−) group of 943 participants and an apathy positive (+) group of 114 participants through the Neuropsychiatric Inventory (NPI)-apathy subitem. Cerebrospinal fluid (CSF) AD biomarkers and amyloid β (Aβ) PET were measured, and their longitudinal changes were assessed using linear mixed-effects models. Risk factors for cognitive decline and apathy conversion were explored through the Cox proportional hazards model. Mediation effects of Aβ pathology on cognition were investigated using the causal mediation analysis. Apathy syndrome was associated with faster impairment of cognition and elevation of the Aβ burden. The effects of apathy on cognitive function and life quality were mediated by Aβ pathology, including CSF Aβ42/total tau ratio, and Aβ deposition in the prefrontal regions. Apathy syndrome was the risk factor for cognitive deterioration; meanwhile, frontal Aβ burden was the risk factor for apathy conversion. Apathy syndrome is an early manifestation of cognitive decline and there are bidirectional roles between apathy syndrome and Aβ pathology. Prefrontal Aβ pathology influenced the pathway from apathy to cognitive decline.

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EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v95869 ◽

1998 ◽

Vol 9 (5) ◽

pp. 869-876 ◽

Cited By ~ 2

Author(s):

B Hoen ◽

A Paul-Dauphin ◽

D Hestin ◽

M Kessler

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Proportional Hazards Model ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Chronic Hemodialysis ◽

Cox Proportional Hazards Model ◽

Coagulase Negative Staphylococci ◽

Synthetic Membranes

Bacteremic infections are a major cause of mortality and morbidity in chronic hemodialysis patients. New developments in managing these patients (erythropoietin therapy, nasal mupirocin, long-term implanted catheters, and synthetic membranes) may have altered the epidemiologic patterns of bacteremia in dialysis patients. This multicenter prospective cross-sectional study was carried out to determine the current incidence of and risk factors for bacteremia in chronic hemodialysis patients in France. A total of 988 adults on chronic hemodialysis for 1 mo or longer was followed up prospectively for 6 mo in 19 French dialysis units. The factors associated with the development of at least one bacteremic episode over 6 mo were determined using the multivariate Cox proportional hazards model. Staphylococcus aureus (n=20) and coagulase-negative staphylococci (n=15) were responsible for most of the 51 bacteremic episodes recorded. The incidence of bacteremia was 0.93 episode per 100 patient-months. Four risk factors for bacteremia were identified: (1) vascular access (catheter versus fistula: RR=7.6; 95% CI, 3.7 to 15.6); (2) history of bacteremia (> or =2 versus no previous episode: RR=7.3; 95% CI, 3.2 to 16.4); (3) immunosuppressive therapy (current versus no: RR=3.0; 95% CI, 1.0 to 6.1); and (4) corpuscular hemoglobin (per 1 g/dl increment: RR=0.7; 95% CI, 0.6 to 0.9). Catheters, especially long-term implanted catheters, were found to be the leading risk factor of bacteremia in chronic hemodialysis patients. There was a trend toward recurrence of bacteremia that was not associated with chronic staphylococcal nasal carriage. Synthetic membranes were not associated with a lower risk of bacteremia in this population of well dialyzed patients, but anemia linked to resistance to erythropoietin appeared to be a possible risk factor for bacteremia.

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