Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
QJM. 2017 Jul 1;110(7):425-430. doi: 10.1093/qjmed/hcx004.
Empyema is a rare but important complication among patients with end-stage renal disease (ESRD). However, a nationwide, propensity-matched cohort study has never been performed.
We conducted a retrospective cohort study using data from the National Health Insurance Research Database of Taiwan. The ESRD group consisted of 82 765 patients diagnosed between 2000 and 2008. The comparison group consisted of individuals without kidney disease selected at a 1:1 ratio matched by propensity score estimated with age, gender, year of diagnosis and comorbidities. The occurrence of empyema was monitored until the end of 2011. The hazard ratios (HRs) of empyema were estimated using the Cox proportional hazards model.
The incidence of empyema was 2.76-fold higher in the ESRD group than in the comparison group (23.7 vs. 8.19/10 000 person-years, P <0.001), with an adjusted HR of 3.01 [95% confidence interval (CI) = 2.67-3.39]. There was no difference of the incidence of empyema between hemodialysis (HD) and peritoneal dialysis (PD) (adjusted HR = 0.96, 95% CI = 0.75-1.23). In addition, 30-day mortality rate since empyema diagnosis was significantly higher in ESRD group than the comparison group (15.9% vs. 10.9%), with an adjusted OR of 1.69 (95% CI = 1.17-2.44).
The risk of empyema was significantly higher in patients with ESRD than in those without kidney disease. The occurrence of empyema was without difference in patients undergoing HD compared to those undergoing PD. The 30-day mortality rate since empyema diagnosis was also significantly higher in patients with ESRD.
脓胸是终末期肾病（ESRD）患者的一种罕见但重要的并发症。然而，目前尚未开展全国范围内的倾向评分匹配队列研究。
我们使用来自中国台湾全民健康保险研究数据库的数据进行了一项回顾性队列研究。ESRD 组包含 2000 年至 2008 年间确诊的 82765 例患者。对照组由年龄、性别、诊断年份和合并症相匹配的无肾脏疾病个体组成，匹配比例为 1:1。监测脓胸的发生情况，直至 2011 年底。使用 Cox 比例风险模型估计脓胸的风险比（HR）。
ESRD 组脓胸的发生率比对照组高 2.76 倍（23.7 比 8.19/10000 人年，P<0.001），调整后的 HR 为 3.01（95%可信区间[CI]：2.67-3.39）。血液透析（HD）和腹膜透析（PD）患者的脓胸发生率无差异（调整后的 HR：0.96，95%CI：0.75-1.23）。此外，ESRD 组脓胸诊断后 30 天死亡率明显高于对照组（15.9%比 10.9%），调整后的比值比（OR）为 1.69（95%CI：1.17-2.44）。
ESRD 患者发生脓胸的风险明显高于无肾脏疾病患者。HD 患者与 PD 患者相比，脓胸的发生率无差异。ESRD 患者脓胸诊断后 30 天死亡率也明显更高。
