Ishikawa Yuichi, Nakano Kazuhisa, Tokutsu Kei, Nakayamada Shingo, Matsuda Shinya, Fushimi Kiyohide, Tanaka Yoshiya
The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
Sato Clinic, Ebisu, Shibuya-ku, Tokyo, Japan.
Front Med (Lausanne). 2022 Mar 4;9:843809. doi: 10.3389/fmed.2022.843809. eCollection 2022.
Short-term mortality and incidence of cerebrovascular and cardiovascular events (C-CVE) during hospitalization of patients with severe herpes zoster (HZ) have not been sufficiently investigated. We aimed to investigate short-term prognosis and incidence of C-CVE associated with HZ in hospitalized patients.
This retrospective cohort study from April 2016 to March 2018 included HZ inpatient cases selected from the Diagnosis Procedure Combination database-a Japanese nationwide inpatient database. HZ and C-CVE were diagnosed based on the 10 revision of the International Classification of Diseases and Injuries codes. The definition of primary exposure was that treatments were initiated within 7 days of admission, and antivirals were administered for ≥7 days. Main Outcomes were in-hospital deaths and C-CVE onset after hospitalization.
Among 16,811,501 in-hospital cases registered from 1,208 hospitals, 29,054 cases with HZ were enrolled. The median age was 71.0 years, 15,202 cases (52.3%) were female, and the HZ types were the central nervous system (n=9,034), disseminated (n=3,051), and ophthalmicus (n=1,069) types. There were 301 (1.0%) in-hospital deaths and 385 (1.3%) post-hospitalization onset of C-CVE. The 30-day in-hospital survival rates with or without underlying disease were 96.8% and 98.5%, respectively. Age ≥75 years (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.55-3.05), liver cirrhosis or hepatic failure (HR, 5.93; 95% CI, 2.16-16.27), chronic kidney disease (HR, 1.82; 95% CI, 1.24-2.68), heart failure (HR, 1.65; 95% CI, 1.22-2.24), and old cerebrovascular events (HR, 1.92; 95% CI, 1.10-3.34) were associated with poor short-term prognosis. Age ≥75 years (odds ratio [OR], 1.70; 95% CI, 1.29-2.24), diabetes (OR, 1.50; 95% CI, 1.19-1.89), dyslipidemia (OR, 1.95; 95% CI, 1.51-2.51), hyperuricemia (OR, 1.63; 95% CI, 1.18-2.27), hypertension (OR, 1.76; 95% CI, 1.40-2.20), heart failure (OR, 1.84; 95% CI, 1.32-2.55), and glucocorticoid administration (OR, 1.59; 95% CI, 1.25-2.01) were associated with increased risks for in-hospital C-CVE onset.
The underlying diseases that could influence the short-term mortality of severe HZ were identified. Glucocorticoid is a possible risk factor for the in-hospital onset of C-CVE after severe HZ development.
严重带状疱疹（HZ）患者住院期间的短期死亡率以及脑血管和心血管事件（C-CVE）的发生率尚未得到充分研究。我们旨在调查住院患者中与HZ相关的短期预后和C-CVE的发生率。
这项回顾性队列研究涵盖了2016年4月至2018年3月期间从诊断程序组合数据库（一个日本全国性住院患者数据库）中选取的HZ住院病例。HZ和C-CVE根据国际疾病和损伤分类代码第10版进行诊断。主要暴露的定义是在入院后7天内开始治疗，且抗病毒药物给药≥7天。主要结局是住院期间死亡和住院后C-CVE发病。
在1208家医院登记的16811501例住院病例中，有29054例HZ患者被纳入研究。中位年龄为71.0岁，15202例（52.3%）为女性，HZ类型包括中枢神经系统型（n = 9034）、播散型（n = 3051）和眼型（n = 1069）。有301例（1.0%）住院期间死亡，385例（1.3%）住院后发生C-CVE。有或无基础疾病的患者30天住院生存率分别为96.8%和98.5%。年龄≥75岁（风险比[HR]，2.18；95%置信区间[CI]，1.55 - 3.05）、肝硬化或肝衰竭（HR，5.93；CI，2.16 - 16.27）、慢性肾病（HR，1.82；CI，1.24 - 2.68）、心力衰竭（HR，1.65；CI，1.22 - 2.24）和既往脑血管事件（HR，1.92；CI，1.10 - 3.34）与短期预后不良相关。年龄≥75岁（比值比[OR]，1.70；CI，1.29 - 2.24）、糖尿病（OR，1.50；CI，1.19 - 1.89）、血脂异常（OR，1.95；CI，1.51 - 2.51）、高尿酸血症（OR，1.63；CI，1.18 - 2.27）、高血压（OR，1.76；CI，1.40 - 2.20）、心力衰竭（OR，1.84；CI，1.32 - 2.55）和使用糖皮质激素（OR，1.59；CI，1.25 - 2.01）与住院期间C-CVE发病风险增加相关。
确定了可能影响严重HZ短期死亡率的基础疾病。糖皮质激素是严重HZ发生后住院期间C-CVE发病的一个可能风险因素。
