Incidence of acute complications of herpes zoster among immunocompetent adults in England: a matched cohort study using routine health data.

BACKGROUND: Herpes zoster can cause rare but serious complications; the frequency of these complications has not been well described. OBJECTIVES: To quantify the risks of acute non-postherpetic neuralgia (PHN) zoster complications, to inform vaccination policy. METHODS: We conducted a cohort study among unvaccinated immunocompetent adults with incident zoster, and age-, sex- and practice-matched control adults without zoster, using routinely collected health data from the UK Clinical Practice Research Datalink (years 2001 to 2018). Crude attributable risks of complications were estimated as the difference between Kaplan-Meier-estimated 3-month cumulative incidences in patients with zoster vs. controls. We used Cox models to obtain hazard ratios for our primary outcomes in patients with and without zoster. Primary outcomes were ocular, neurological, cutaneous, visceral and zoster-specific complications. We also assessed whether antivirals during acute zoster protected against the complications. RESULTS: In total 178 964 incident cases of zoster and 1 799 380 controls were included. The absolute risks of zoster-specific complications within 3 months of zoster diagnosis were 0·37% [95% confidence interval (CI) 0·34-0·39] for Ramsay Hunt syndrome, 0·01% (95% CI 0·0-0·01) for disseminated zoster, 0·04% (95% CI 0·03-0·05) for zoster death and 0·97% (95% CI 0·92-1·00) for zoster hospitalization. For other complications, attributable risks were 0·48% (95% CI 0·44-0·51) for neurological complications, 1·33% (95% CI 1·28-1·39) for ocular complications, 0·29% (95% CI 0·26-0·32) for cutaneous complications and 0·78% (95% CI 0·73-0·84) for visceral complications. Attributable risks were higher among patients > 50 years old. Patients with zoster had raised risks of all primary outcomes relative to controls. Antiviral prescription was associated with reduced risk of neurological complications (hazard ratio 0·61, 95% CI 0·53-0·70). CONCLUSIONS: Non-PHN complications of zoster were relatively common, which may affect cost-effectiveness calculations for zoster vaccination. Clinicians should be aware that zoster can lead to various complications, besides PHN.

Acute kidney injury in stable COPD and at exacerbation.

BACKGROUND: While acute kidney injury (AKI) alone is associated with increased mortality, the incidence of hospital admission with AKI among stable and exacerbating COPD patients and the effect of concurrent AKI at COPD exacerbation on mortality is not known. METHODS: A total of 189,561 individuals with COPD were identified from the Clinical Practice Research Datalink. Using Poisson and logistic regressions, we explored which factors predicted admission for AKI (identified in Hospital Episode Statistics) in this COPD cohort and concomitant AKI at a hospitalization for COPD exacerbation. Using survival analysis, we investigated the effect of concurrent AKI at exacerbation on mortality (n=36,107) and identified confounding factors. RESULTS: The incidence of AKI in the total COPD cohort was 128/100,000 person-years. The prevalence of concomitant AKI at exacerbation was 1.9%, and the mortality rate in patients with AKI at exacerbation was 521/1,000 person-years. Male sex, older age, and lower glomerular filtration rate predicted higher risk of AKI or death. There was a 1.80 fold (95% confidence interval: 1.61, 2.03) increase in adjusted mortality within the first 6 months post COPD exacerbation in patients suffering from AKI and COPD exacerbation compared to those who were AKI free. CONCLUSION: In comparison to previous studies on general populations and hospitalizations, the incidence and prevalence of AKI is relatively high in COPD patients. Coexisting AKI at exacerbation is prognostic of poor outcome.

New estimates of the burden of acute community-acquired infections among older people with diabetes mellitus: a retrospective cohort study using linked electronic health records.

AIM: To describe the incidence of acute community-acquired infections (lower respiratory tract infections, urinary tract infections and sepsis) among the UK population aged ≥65 years with diabetes mellitus, and all-cause 28-day hospital admission rates and mortality. METHODS: We used electronic primary care records from the Clinical Practice Research Datalink, linked to death certificates and Hospital Episode Statistics admission data, to conduct a retrospective cohort study from 1997 to 2011. RESULTS: Among the 218 805 older people with diabetes there was a high burden of community-acquired infection, lower respiratory tract infections having the highest incidence (crude rate: 152.7/1000 person-years) followed by urinary tract infections (crude rates 51.4 and 147.9/1000 person-years for men and women, respectively). The incidence of all infections increased over time, which appeared to be driven by the population's changing age structure. Most patients diagnosed with pneumonia and sepsis were hospitalized on the same day (77.8 and 75.1%, respectively). For lower respiratory tract infections and urinary tract infections, a large proportion of 28-day hospitalizations were after the day of diagnosis (39.1 and 44.3%, respectively), and a notable proportion of patients (7.1 and 5.1%, respectively) were admitted for a cardiovascular condition. In the 4 weeks after onset, all-cause mortality was 32.1% for pneumonia (3115/9697), 31.7% for sepsis (780/2461), 4.1% for lower respiratory tract infections (5685/139 301) and 1.6% for urinary tract infections (1472/91 574). CONCLUSIONS: The present large cohort study provides up-to-date detailed infection incidence estimates among older people with diabetes in the community, with variation by age, sex and region and over time. This should be of use for patient communication of risk and future healthcare planning.