The Risk of Subsequent Deep Vein Thrombosis and Pulmonary Embolism in Patients with Nontyphoidal Salmonellosis: A Nationwide Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Study Design
2.2. Study Population
2.3. Outcome and Relevant Variables
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Risk of DVT and PE
3.3. Analysis Stratified by Sex, Age, and Co-Morbidities
3.4. Sensitivity Analysis
3.5. Time Trends for Risk of DVT and PE
3.6. Cumulative Incidences Completing Risk Analysis of DVT and PE in NTS and non-NTS Groups
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Nontyphoidal Salmonellosis | p Value | ||
---|---|---|---|
No (N = 71,420) | Yes (N = 17,855) | ||
n (%) | n (%) | ||
Age, years | 1.00 | ||
18–39 | 18,900 (26.5) | 4725 (26.5) | |
40–64 | 26,048 (36.5) | 6512 (36.5) | |
≥65 | 26,472 (37.1) | 6618 (37.1) | |
Mean (SD) * | 55.3 (19.7) | 55.4 (19.7) | 0.62 * |
Gender | 1.00 | ||
Female | 32,204 (0.45) | 8051 (0.45) | |
Male | 39,216 (0.55) | 9804 (0.55) | |
Comorbidities | 16,732 (23.4) | 7951 (44.5) | <0.001 |
Hypertension | 9376 (0.13) | 4313 (0.24) | <0.001 |
Diabetes | 4968 (0.07) | 2854 (0.16) | <0.001 |
Hyperlipidemia | 2219 (0.03) | 1224 (0.07) | <0.001 |
Coronary artery disease | 4465 (0.06) | 2117 (0.12) | <0.001 |
Cerebrovascular accident | 4104 (0.06) | 1664 (0.09) | <0.001 |
Chronic Kidney disease | 586 (0.01) | 687 (0.04) | <0.001 |
Cancer | 2368 (0.03) | 1977 (0.11) | <0.001 |
Chronic Obstructive Pulmonary Disease | 2359 (0.03) | 1453 (0.08) | <0.001 |
Sleep apnea | 66 (0.001) | 41 (0.002) | <0.001 |
Rheumatoid arthritis | 144 (0.002) | 190 (0.01) | <0.001 |
Atrial fibrillation | 916 (0.01) | 537 (0.03) | <0.001 |
Chronic liver disease | 553 (0.01) | 419 (0.02) | 0.75 |
Pregnancy | 13 (0.0002) | 2 (0.0001) | <0.001 |
Lower leg fracture or surgery | 2935 (0.04) | 1121 (0.06) | <0.001 |
Mortality | 5560 (7.78) | 4290 (24.0) | <0.001 |
Variables | Event | Crude HR ‡ | Adjusted HR § | SHR | |||||
---|---|---|---|---|---|---|---|---|---|
n | PY | Rate † | (95% CI) | (95% CI) | (95% CI) | ||||
DVT | |||||||||
Non-NTS | 215 | 450,270 | 4.77 | 1.00 | - | 1.00 | - | 1.00 | - |
NTS | 109 | 88,183 | 12.36 | 2.54 | (2.02 to 3.20) *** | 2.35 | (1.86 to 2.98) *** | 1.83 | (1.44 to 2.31) *** |
Gender | |||||||||
Female | 154 | 248,049 | 6.21 | 1.00 | - | ||||
Male | 170 | 290,404 | 5.85 | 0.94 | (0.75 to 1.17) | ||||
Age | |||||||||
18–39 | 22 | 164,576 | 1.34 | 1.00 | - | 1.00 | - | 1.00 | - |
40–64 | 82 | 209,177 | 3.92 | 2.91 | (1.82 to 4.66) *** | 2.49 | (1.55 to 4.01) *** | 2.93 | (1.47 to 3.90) *** |
≥65 | 220 | 164,700 | 13.36 | 9.68 | (6.24 to 15.0) *** | 6.41 | (4.04 to 10.2) *** | 5.58 | (3.38 to 9.22) *** |
Comorbidities | |||||||||
No | 142 | 432,486 | 3.28 | 1.00 | - | 1.00 | - | 1.00 | - |
Yes | 182 | 105,967 | 17.18 | 5.06 | (4.05 to 6.32) *** | 2.58 | (2.02 to 3.29) *** | 2.09 | (1.60 to 2.73) *** |
PE | |||||||||
Non-NTS | 109 | 450,270 | 2.42 | 1.00 | - | 1.00 | - | 1.00 | - |
NTS | 53 | 88,183 | 6.01 | 2.46 | (1.77 to 3.41) *** | 2.36 | (1.69 to 3.30) *** | 1.84 | (1.30 to 2.60) *** |
Gender | |||||||||
Female | 76 | 248,049 | 3.06 | 1.00 | - | ||||
Male | 86 | 290,404 | 2.96 | 0.96 | (0.71 to 1.31) | ||||
Age | |||||||||
18–39 | 15 | 164,576 | 0.91 | 1.00 | - | 1.00 | - | 1.00 | - |
40–64 | 43 | 209,177 | 2.06 | 2.28 | (1.26 to 4.10) *** | 2.05 | (1.13 to 3.71) * | 1.96 | (1.08 to 3.56) * |
≥65 | 104 | 164,700 | 6.31 | 7.09 | (4.12 to 12.2) *** | 5.27 | (2.97 to 9.37) *** | 4.51 | (2.46 to 8.26) *** |
Comorbidities | |||||||||
No | 82 | 432,486 | 1.9 | 1.00 | - | 1.00 | - | 1.00 | - |
Yes | 80 | 105,967 | 7.55 | 4.09 | (2.99 to 5.59) *** | 2.15 | (1.52 to 3.03) *** | 1.68 | (1.15 to 2.47) ** |
Variables | Salmonellosis | Compared to Control | p for Interaction | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Yes | No | Crude HR ‡ | Adjusted HR § | ||||||||
Events | Events | ||||||||||
n | PY | Rate † | n | PY | Rate † | (95% CI) | (95% CI) | ||||
DVT | |||||||||||
Gender | 0.86 | ||||||||||
Female | 54 | 42,315 | 12.8 | 100 | 205,734 | 4.86 | 2.61 | (1.87 to 3.63) *** | 2.34 | (1.67 to 3.28) *** | |
Male | 55 | 45,868 | 12.0 | 115 | 244,536 | 4.70 | 2.48 | (1.80 to 3.42) *** | 2.26 | (1.63 to 3.14) *** | |
Age, years | <0.001 | ||||||||||
18–39 | 16 | 30,710 | 5.21 | 6 | 133,866 | 0.45 | 11.4 | (4.44 to 29.0) *** | 5.95 | (2.22 to 15.9) *** | |
40–64 | 38 | 34,158 | 11.1 | 44 | 175,018 | 2.51 | 4.37 | (2.83 to 6.74) *** | 3.40 | (2.16 to 5.34) *** | |
≥65 | 55 | 23,315 | 23.6 | 165 | 141,385 | 11.67 | 1.99 | (1.47 to 2.70) *** | 1.68 | (1.23 to 2.30) ** | |
Comorbidity | 0.54 | ||||||||||
NO | 33 | 61,849 | 5.34 | 109 | 370,637 | 2.94 | 1.82 | (1.24 to 2.69) *** | 2.33 | (1.58 to 3.45) *** | |
YES | 76 | 26,334 | 28.9 | 106 | 79,633 | 13.3 | 2.10 | (1.57 to 2.83) *** | 2.17 | (1.61 to 2.93) *** | |
Follow-up time, months | 0.06 | ||||||||||
≤2 | 20 | 103 | 1950 | 2 | 26 | 775 | 0.70 | (0.31 to 1.58) | 0.71 | (0.31 to 1.67) | |
3–12 | 25 | 868 | 288 | 10 | 944 | 106 | 1.25 | (0.72 to 2.19) | 1.42 | (0.79 to 2.56) | |
>12 | 64 | 87,212 | 7.34 | 97 | 449,300 | 2.16 | 1.84 | (1.38 to 2.44) *** | 1.75 | (1.31 to 2.34) *** | |
PE | |||||||||||
Gender | 0.06 | ||||||||||
Female | 20 | 42,315 | 4.73 | 56 | 205,734 | 2.72 | 1.73 | (1.04 to 2.89) ** | 1.65 | (0.98 to 2.77) | |
Male | 33 | 45,868 | 7.19 | 53 | 244,536 | 2.17 | 3.26 | (2.11 to 5.04) *** | 3.04 | (1.94 to 4.75) *** | |
Age, years | 0.004 | ||||||||||
18–39 | 10 | 30,710 | 3.26 | 5 | 133,866 | 0.37 | 8.48 | (2.90 to 24.8) *** | 6.72 | (2.23 to 20.3) *** | |
40–64 | 20 | 34,158 | 5.86 | 23 | 175,018 | 1.31 | 4.39 | (2.41 to 8.00) *** | 3.28 | (1.75 to 6.13) *** | |
≥65 | 23 | 23,315 | 9.86 | 81 | 141,385 | 5.73 | 1.77 | (1.11 to 2.82 ) ** | 1.54 | (0.96 to 2.47) | |
Comorbidity | <0.001 | ||||||||||
NO | 24 | 61,849 | 3.88 | 58 | 370,637 | 1.56 | 2.47 | (1.54 to 3.98) *** | 3.05 | (1.89 to 4.92) *** | |
YES | 29 | 26,334 | 11.01 | 51 | 79,633 | 6.40 | 1.70 | (1.08 to 2.68) ** | 1.74 | (1.10 to 2.77) * | |
Follow-up time, months | 0.73 | ||||||||||
≤2 | 2 | 103 | 195 | 8 | 26 | 3100 | 1.16 | (0.25 to 5.38) | 1.12 | (0.22 to 5.73) | |
3–12 | 10 | 868 | 115 | 15 | 944 | 159 | 1.94 | (0.87 to 4.33) | 2.41 | (1.04 to 5.55) * | |
>12 | 97 | 87,212 | 11.1 | 29 | 449,300 | 0.6 | 1.57 | (1.04 to 2.37) * | 1.56 | (1.03 to 2.38) * |
Variable | Event | Crude HR ‡ | Adjusted HR § | SHR | |||||
---|---|---|---|---|---|---|---|---|---|
n | PY | Rate† | (95% CI) | (95% CI) | (95% CI) | ||||
Primary analysis (frequency matching) | |||||||||
DVT | |||||||||
non-NTS | 215 | 450,270 | 4.77 | 1.00 | - | 1.00 | - | 1.00 | - |
NTS | 109 | 88,183 | 12.36 | 2.54 | (2.02 to 3.20) *** | 2.35 | (1.86 to 2.98) *** | 1.83 | (1.44 to 2.31) *** |
PE | |||||||||
non-NTS | 109 | 450,270 | 2.42 | 1.00 | - | 1.00 | - | 1.00 | - |
NTS | 53 | 88,183 | 6.01 | 2.46 | (1.77 to 3.41) *** | 2.36 | (1.69 to 3.30) *** | 1.84 | (1.30 to 2.60) *** |
Sensitivity analysis (PSM) | |||||||||
DVT | |||||||||
non-NTS | 256 | 425,265 | 6.02 | 1.00 | - | 1.00 | - | 1.00 | - |
NTS | 102 | 88,109 | 11.6 | 1.90 | (1.51 to 2.38) *** | 2.17 | (1.72 to 2.73) *** | 1.69 | (1.34 to 2.13) *** |
PE | |||||||||
non-NTS | 113 | 425,265 | 2.66 | 1.00 | - | 1.00 | - | 1.00 | - |
NTS | 47 | 88,109 | 5.33 | 1.98 | (1.41 to 2.78) *** | 2.16 | (1.53 to 3.05) *** | 1.71 | (1.21 to 2.40) ** |
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Chang, R.; Wu, D.-K.; Wei, J.C.-C.; Yip, H.-T.; Hung, Y.-M.; Hung, C.-H. The Risk of Subsequent Deep Vein Thrombosis and Pulmonary Embolism in Patients with Nontyphoidal Salmonellosis: A Nationwide Cohort Study. Int. J. Environ. Res. Public Health 2020, 17, 3567. https://doi.org/10.3390/ijerph17103567
Chang R, Wu D-K, Wei JC-C, Yip H-T, Hung Y-M, Hung C-H. The Risk of Subsequent Deep Vein Thrombosis and Pulmonary Embolism in Patients with Nontyphoidal Salmonellosis: A Nationwide Cohort Study. International Journal of Environmental Research and Public Health. 2020; 17(10):3567. https://doi.org/10.3390/ijerph17103567
Chicago/Turabian StyleChang, Renin, Den-Ko Wu, James Cheng-Chung Wei, Hei-Tung Yip, Yao-Min Hung, and Chih-Hsin Hung. 2020. "The Risk of Subsequent Deep Vein Thrombosis and Pulmonary Embolism in Patients with Nontyphoidal Salmonellosis: A Nationwide Cohort Study" International Journal of Environmental Research and Public Health 17, no. 10: 3567. https://doi.org/10.3390/ijerph17103567