背景:慢性疲劳综合征(CFS)与几种情况有关,包括感染,免疫系统的变化,或情绪压力。我们的研究旨在使用台湾国家健康保险研究数据库的数据评估肺炎诊断后的CFS风险。
方法:在这项嵌套病例对照研究中,我们从2000年1月1日至2017年12月31日的全国人群健康保险索赔数据库中确定了2,000,000名成年患者.使用倾向评分将诊断为致病性感染的每个病例与相应的对照进行匹配。我们排除了20岁以下的人,在索引日期之前有病原体感染史的人,或者那些有不止一种潜在病原体的人。用各自的95%置信区间(CI)估计风险比(HR)和调整后的风险比(aHR),我们应用单变量和多变量Cox比例风险模型。多变量分析纳入了对年龄的调整,性别,和合并症相关的混杂因素。
结果:使用Cox比例风险回归分析评估感染与CFS后续风险之间的关系。非肺部感染和肺部感染人群的发病率密度分别为6.13和8.70/1000人年,分别(调整后的风险比[HR]=1.4,95%置信区间[CI]1.32-1.5)。感染假单胞菌的患者,肺炎克雷伯菌,流感嗜血杆菌,肺炎链球菌,与没有这些病原体的人相比,流感病毒显示出更高的CFS风险(p<0.05)。此外,与对照组相比,肺炎患者发生血栓栓塞的风险显著增加(p<0.05).
BACKGROUND: Chronic fatigue syndrome (CFS) has been linked to several conditions, including infections, immune system changes, or emotional stress. Our study aimed to assess the risk of CFS after a pneumonia diagnosis using data from National Health Insurance Research Database of Taiwan.
METHODS: In this nested case-control study, we identified 2,000,000 adult patients from a nationwide population-based health insurance claims database spanning from January 1, 2000, to December 31, 2017. Each case diagnosed with a pathogenic infection was matched with a corresponding control using propensity scores. We excluded individuals under 20 years of age, those with a history of pathogenic infections before the index date, or those with more than one potential pathogen. To estimate hazard ratios (HR) and the adjusted hazard ratio (aHR) with their respective 95 % confidence intervals (CI), we applied univariable and multivariable Cox proportional hazard models. The multivariable analysis incorporated adjustments for age, sex, and comorbidity-related confounders.
RESULTS: The relationship between infection and the subsequent risk of CFS was assessed using Cox proportional hazards regression analysis. The incidence density rates were 6.13 and 8.70 per 1000 person-years among the non-pulmonary infection and pulmonary infection populations, respectively (adjusted hazard ratio [HR] = 1.4, 95 % confidence interval [CI] 1.32-1.5). Patients infected with Pseudomonas, Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, and influenza virus exhibited a significantly higher risk of CFS than those without these pathogens (p < 0.05). Additionally, patients with pneumonia had a significantly increased risk of thromboembolism compare with control group (p < 0.05).