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Risk of empyema in patients with chronic liver disease and cirrhosis: A nationwide, population‐based cohort study
Author(s) -
Shen TeChun,
Chen ChiaHung,
Lai HsuehChou,
Lin ChengLi,
Tu ChihYen,
Hsia TeChun,
Shih ChuenMing,
Hsu WuHuei,
Sung FungChang
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13330
Subject(s) - medicine , cirrhosis , cohort , hazard ratio , population , cohort study , empyema , chronic liver disease , proportional hazards model , confidence interval , surgery , environmental health
Background Empyema is an important complication for patients with chronic liver disease and cirrhosis ( CLDC ). However, no study has investigated this relationship by using a population‐based cohort study. Methods We used the National Health Insurance Research Data of Taiwan to identify a cohort of 76 027 CLDC patients newly diagnosed in 2000‐2010 and a comparison cohort without CLDC of same size matched by age, gender and the year of diagnosis. The occurrence of empyema was monitored until the end of 2011. The hazard ratios ( HR s) of empyema were estimated using the Cox model. Results The overall incidence of empyema was 66% greater in the CLDC group than in the non‐ CLDC group (3.85 vs 2.32/10 000 person‐years, P <.001), with an adjusted HR of 1.54 (95% confidence interval [ CI ]=1.24‐1.90). Compared with those without CLDC , adjusted HR s of empyema were 4.96 (95% CI =3.40‐7.24) for patients with cirrhosis and 4.75 (95% CI =3.11‐7.24) for patients with alcoholic CLDC . Further analyses revealed significant adjusted HR s of empyema among CLDC patients with ascites (5.76, 95% CI =4.13‐8.04) and with gastrointestinal haemorrhage (1.60, 95% CI =1.03‐2.48), compared to those without the respective disorders. Analyses using propensity score matched CLDC and non‐ CLDC cohorts revealed similar results. Conclusion The present study shows that CLDC patients have an increased risk of empyema. These patients need timely monitor for the risk of empyema, particularly for those with comorbid cirrhosis, alcoholic disorder, gastrointestinal haemorrhage and ascites.