Long-term mortality of acetaminophen poisoning: a nationwide population-based cohort study with 10-year follow-up in Taiwan.

BACKGROUND: The long-term mortality of acetaminophen (APAP) poisoning has not yet been well studied; hence, we conducted this study to gain understanding of this issue. METHODS: We conducted a nationwide population-based cohort study by identifying 3235 participants with APAP poisoning and 9705 participants without APAP poisoning in Taiwan between 2003 and 2012 in the Nationwide Poisoning Database and Longitudinal Health Insurance Database 2000. Participants with APAP poisoning and control subjects were compared for the risk of all-cause mortality by follow-up until 2013. RESULTS: Two hundred forty-one participants with APAP poisoning (7.5%) and ninety-four control subjects (1.0%) died during the follow-up. Participants with APAP poisoning had a higher risk of all-cause mortality than the control subjects (incidence rate ratio [IRR], 8.1; 95% confidence interval [CI], 6.3-10.2), especially in the subgroup aged 20 years and younger (IRR, 27.3; 95% CI, 3.5-215.5) and in the first 12 months after poisoning (IRR, 16.0; 95% CI, 9.9-25.7). The increased risk of all-cause mortality was found even up to 2 years after the index poisoning. CONCLUSION: APAP poisoning was associated with increased long-term mortality. Early referral for intensive aftercare and associated interventions are suggested; however, further studies of the method are needed for clarification.

Predicting the mortality in geriatric patients with dengue fever.

Geriatric patients have high mortality for dengue fever (DF); however, there is no adequate method to predict mortality in geriatric patients. Therefore, we conducted this study to develop a tool in an attempt to address this issue.We conducted a retrospective case-control study in a tertiary medical center during the DF outbreak in Taiwan in 2015. All the geriatric patients (aged ≥65 years) who visited the study hospital between September 1, 2015, and December 31, 2015, were recruited into this study. Variables included demographic data, vital signs, symptoms and signs, comorbidities, living status, laboratory data, and 30-day mortality. We investigated independent mortality predictors by univariate analysis and multivariate logistic regression analysis and then combined these predictors to predict the mortality.A total of 627 geriatric DF patients were recruited, with a mortality rate of 4.3% (27 deaths and 600 survivals). The following 4 independent mortality predictors were identified: severe coma [Glasgow Coma Scale: ≤8; adjusted odds ratio (AOR): 11.36; 95% confidence interval (CI): 1.89-68.19], bedridden (AOR: 10.46; 95% CI: 1.58-69.16), severe hepatitis (aspartate aminotransferase >1000 U/L; AOR: 96.08; 95% CI: 14.11-654.40), and renal failure (serum creatinine >2 mg/dL; AOR: 6.03; 95% CI: 1.50-24.24). When we combined the predictors, we found that the sensitivity, specificity, positive predictive value, and negative predictive value for patients with 1 or more predictors were 70.37%, 88.17%, 21.11%, and 98.51%, respectively. For patients with 2 or more predictors, the respective values were 33.33%, 99.44%, 57.14%, and 98.51%.We developed a new method to help decision making. Among geriatric patients with none of the predictors, the survival rate was 98.51%, and among those with 2 or more predictors, the mortality rate was 57.14%. This method is simple and useful, especially in an outbreak.

Increased risk for hypothyroidism after anticholinesterase pesticide poisoning: a nationwide population-based study.

PURPOSE: Previous animal studies have reported that acute anticholinesterase pesticide (organophosphate and carbamate) poisoning may affect thyroid hormones. However, there is no human study investigating the association between hypothyroidism and anticholinesterase pesticide poisoning, and therefore, we conducted a retrospective nationwide population-based cohort study to delineate this issue. METHODS: We identified 10,372 anticholinesterase pesticide poisoning subjects and matched 31,116 non-anticholinesterase pesticide poisoning subjects between 2003 and 2012 from the Nationwide Poisoning Database and the Longitudinal Health Insurance Database 2000, respectively, in a 1:3 ratio by index date, age, and sex for this study. We compared the cumulative incidence of hypothyroidism between the two cohorts by following up until 2013. Independent predictors for hypothyroidism were also investigated. RESULTS: In total, 75 (0.72%) anticholinesterase pesticide poisoning subjects and 184 (0.59%) non-anticholinesterase pesticide poisoning subjects were diagnosed with hypothyroidism during the follow-up. Cox proportional hazard regression analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects (adjusted hazard ratio: 1.47, 95% confidence interval: 1.11-1.95) after adjusting for age, sex, hypertension, malignancy, liver disease, renal disease, atrial fibrillation or flutter, thyroiditis, goiter, other endocrine disorders, and mental disorder. Stratified analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects in terms of the age subgroup of 40-64 years, female sex, past history of goiter, follow-up of <1 month, and anticholinesterase pesticide poisoning subjects without atropine treatment (incidence rate ratio [IRR]: 1.66, 95% confidence interval: 1.20-2.30). Female sex, malignancy, renal disease, thyroiditis, goiter, mental disorder, and anticholinesterase pesticide poisoning without atropine treatment were independent predictors for hypothyroidism. CONCLUSIONS: Anticholinesterase pesticide poisoning is associated with increased risk for hypothyroidism. Early evaluation of thyroid function in anticholinesterase pesticide poisoning subjects is suggested, especially in subjects without atropine treatment, aged 40-64 years, female sex, and past history of goiter.

Chronic osteomyelitis increases long-term mortality risk in the elderly: a nationwide population-based cohort study.

BACKGROUND: The elderly are predisposed to chronic osteomyelitis because of the immunocompromised nature of aging and increasing number of chronic comorbidities. Chronic osteomyelitis may significantly affect the health of the elderly; however, its impact on long-term mortality remains unclear. We conceived this retrospective nationwide population-based cohort study to address this issue. METHODS: We identified 10,615 elderly patients (≥65 years) comprising 965 patients with chronic osteomyelitis and 9650 without chronic osteomyelitis matched at a ratio of 1:10 by age and gender between 1999 and 2010 from the Taiwan National Health Insurance Research Database. The risk of chronic osteomyelitis between the two cohorts was compared by a following-up until 2011. RESULTS: Patients with chronic osteomyelitis had a significantly higher mortality risk than those without chronic osteomyelitis [incidence rate ratio (IRR): 2.29; 95 % confidence interval (CI): 2.01-2.59], particularly the old elderly (≥85 years; IRR: 3.27; 95 % CI: 2.22-4.82) and males (IRR: 2.7; 95 % CI: 2.31-3.16). The highest mortality risk was observed in the first month (IRR: 5.01; 95 % CI: 2.02-12.42), and it remained persistently higher even after 6 years (IRR: 1.53; 95 % CI: 1.13-2.06) of follow-up. Cox proportional hazard regression analysis showed that chronic osteomyelitis [adjusted hazard ratio (AHR): 1.89; 95 % CI: 1.66-2.15], advanced age (≥85 years; AHR: 2.02; 95 % CI: 1.70-2.41), male (AHR: 1.34; 95 % CI: 1.22-1.48), and chronic comorbidities were independent predictors of mortality. CONCLUSIONS: This study demonstrated that chronic osteomyelitis significantly increased the long-term mortality risk in the elderly. Therefore, strategies for prevention and treatment of chronic osteomyelitis and concomitant control of chronic comorbidities are very important for the management of the elderly, particularly for a future with an increasingly aged population worldwide.

Acute Anticholinesterase Pesticide Poisoning Caused a Long-Term Mortality Increase: A Nationwide Population-Based Cohort Study.

Acute anticholinesterase pesticide (organophosphate and carbamate) poisoning (ACPP) often produces severe complications, and sometimes death. We investigated the long-term mortality of patients with ACPP because it is not sufficiently understood. In this retrospective nationwide population-based cohort study, 818 patients with ACPP and 16,360 healthy comparisons from 1999 to 2010 were selected from Taiwan's National Health Insurance Research Database. They were followed until 2011. Ninety-four (11.5%) ACPP patients and 793 (4.9%) comparisons died (P < 0.01) during follow-up. The incidence rate ratios (IRRs) of death were 2.5 times higher in ACPP patients than in comparisons (P < 0.01). The risk of death was particularly high in the first month after ACPP (IRR: 92.7; 95% confidence interval [CI]: 45.0-191.0) and still high for ~6 months (IRR: 3.8; 95% CI: 1.9-7.4). After adjusting for age, gender, selected comorbidities, geographic area, and monthly income, the hazard ratio of death for ACPP patients was still 2.4 times higher than for comparisons. Older age (≥35 years), male gender, diabetes mellitus, coronary artery disease, hypertension, stroke, mental disorder, and lower monthly income also predicted death. ACPP significantly increased long-term mortality. In addition to early follow-up after acute treatment, comorbidity control and socioeconomic assistance are needed for patients with ACPP.