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Abstract：
BACKGROUND: Although cases of acute cholecystitis, acute pancreatitis, and acute appendicitis following dengue virus infections have been documented, very few large-scale studies have investigated the postdengue risk of these acute abdominal conditions.
METHODS: This retrospective population-based cohort study included all patients with laboratory-confirmed dengue from 2002 to 2015 in Taiwan and 1:4 nondengue individuals matched by age, sex, area of residence, and symptom onset time. Multivariate Cox proportional hazards regression models were used to investigate the short-term (≤ 30 days), medium-term (31-365 days), and long-term (> 1 year) risks of acute cholecystitis, pancreatitis, and appendicitis after dengue infection, adjusted for age, sex, area of residence, urbanization level, monthly income level, and comorbidities. Bonferroni correction was used for multiple testing; E-values were used to assess the robustness of the results to unmeasured confounding.
RESULTS: This study included 65,694 individuals with dengue and 262,776 individuals without dengue. Patients with dengue had a significantly increased risk of acute cholecystitis (adjusted hazard ratio (aHR) 60.21; 95% CI 29.11-124.54; P < 0.0001, E-value = 119.92) and acute pancreatitis (aHR 17.13; 95% CI 7.66-38.29; P < 0.0001, E-value = 33.75) within the first 30 days postinfection compared to those without dengue, but this increased risk was not present after that. The incidence rates of acute cholecystitis and pancreatitis in the first 30 days were 18.79 and 5.27 per 10,000, respectively. No increased risk of acute appendicitis was observed among patients with acute dengue infection.
CONCLUSIONS: This study was the first large epidemiological study to show a significantly increased risk of acute cholecystitis and pancreatitis among patients with dengue during the acute phase of dengue infection, while no such association was observed for acute appendicitis. Early identification of acute cholecystitis and pancreatitis in patients with dengue is crucial for preventing fatal complications.
METHODS: This retrospective population-based cohort study included all patients with laboratory-confirmed dengue from 2002 to 2015 in Taiwan and 1:4 nondengue individuals matched by age, sex, area of residence, and symptom onset time. Multivariate Cox proportional hazards regression models were used to investigate the short-term (≤ 30 days), medium-term (31-365 days), and long-term (> 1 year) risks of acute cholecystitis, pancreatitis, and appendicitis after dengue infection, adjusted for age, sex, area of residence, urbanization level, monthly income level, and comorbidities. Bonferroni correction was used for multiple testing; E-values were used to assess the robustness of the results to unmeasured confounding.
RESULTS: This study included 65,694 individuals with dengue and 262,776 individuals without dengue. Patients with dengue had a significantly increased risk of acute cholecystitis (adjusted hazard ratio (aHR) 60.21; 95% CI 29.11-124.54; P < 0.0001, E-value = 119.92) and acute pancreatitis (aHR 17.13; 95% CI 7.66-38.29; P < 0.0001, E-value = 33.75) within the first 30 days postinfection compared to those without dengue, but this increased risk was not present after that. The incidence rates of acute cholecystitis and pancreatitis in the first 30 days were 18.79 and 5.27 per 10,000, respectively. No increased risk of acute appendicitis was observed among patients with acute dengue infection.
CONCLUSIONS: This study was the first large epidemiological study to show a significantly increased risk of acute cholecystitis and pancreatitis among patients with dengue during the acute phase of dengue infection, while no such association was observed for acute appendicitis. Early identification of acute cholecystitis and pancreatitis in patients with dengue is crucial for preventing fatal complications.
摘要：
背景：尽管急性胆囊炎病例，急性胰腺炎,登革病毒感染后的急性阑尾炎已经有记录，很少有大规模研究调查这些急性腹部疾病的登革热后风险。
方法：这项以人群为基础的回顾性队列研究纳入了2002年至2015年台湾所有实验室确诊登革热患者和年龄匹配的1:4非登革热患者，性别,居住区,和症状发作时间。采用多因素Cox比例风险回归模型对短期(≤30天)、中期（31-365天），和急性胆囊炎的长期（>1年）风险，胰腺炎,登革热感染后的阑尾炎，根据年龄调整，性别,居住区,城市化水平,月收入水平,和合并症。Bonferroni校正用于多次测试；E值用于评估结果对未测量的混杂的稳健性。
结果：本研究包括65,694名登革热患者和262,776名无登革热患者。与没有登革热的患者相比，登革热患者在感染后的前30天内发生急性胆囊炎的风险显着增加（调整后的风险比（aHR）60.21;95％CI29.11-124.54;P<0.0001，E值=119.92）和急性胰腺炎（aHR17.13;95％CI7.66-38.29;P<0.0001，E值=33.75），但这种增加的风险在那之后并不存在。前30天急性胆囊炎和胰腺炎的发病率分别为18.79和5.27/10,000。在急性登革热感染患者中没有观察到急性阑尾炎的风险增加。
结论：这项研究是第一个大型流行病学研究，显示登革热患者在登革热感染急性期发生急性胆囊炎和胰腺炎的风险显著增加，而急性阑尾炎没有观察到这种关联。早期识别登革热患者的急性胆囊炎和胰腺炎对于预防致命并发症至关重要。
方法：这项以人群为基础的回顾性队列研究纳入了2002年至2015年台湾所有实验室确诊登革热患者和年龄匹配的1:4非登革热患者，性别,居住区,和症状发作时间。采用多因素Cox比例风险回归模型对短期(≤30天)、中期（31-365天），和急性胆囊炎的长期（>1年）风险，胰腺炎,登革热感染后的阑尾炎，根据年龄调整，性别,居住区,城市化水平,月收入水平,和合并症。Bonferroni校正用于多次测试；E值用于评估结果对未测量的混杂的稳健性。
结果：本研究包括65,694名登革热患者和262,776名无登革热患者。与没有登革热的患者相比，登革热患者在感染后的前30天内发生急性胆囊炎的风险显着增加（调整后的风险比（aHR）60.21;95％CI29.11-124.54;P<0.0001，E值=119.92）和急性胰腺炎（aHR17.13;95％CI7.66-38.29;P<0.0001，E值=33.75），但这种增加的风险在那之后并不存在。前30天急性胆囊炎和胰腺炎的发病率分别为18.79和5.27/10,000。在急性登革热感染患者中没有观察到急性阑尾炎的风险增加。
结论：这项研究是第一个大型流行病学研究，显示登革热患者在登革热感染急性期发生急性胆囊炎和胰腺炎的风险显著增加，而急性阑尾炎没有观察到这种关联。早期识别登革热患者的急性胆囊炎和胰腺炎对于预防致命并发症至关重要。
