High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study.

Geng-He Chang,Yao-Hsu Yang,Ming-Shao Tsai,Meng-Hung Lin,Ching-Yuan Wu,Chia-Yen Liu,Yung-Hsiang Lin,Meng-Chang Ding,Cheng-Ming Hsu

doi:10.3390/jcm7110385

Geng-He Chang, Yao-Hsu Yang + Show 7 more

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https://doi.org/10.3390/jcm7110385

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Abstract

Objective: To investigate the risk of deep neck infection (DNI) in patients with type 1 diabetes mellitus (T1DM). Methods: The database of the Registry for Catastrophic Illness Patients, affiliated to the Taiwan National Health Insurance Research Database, was used to conduct a retrospective cohort study. In total, 5741 patients with T1DM and 22,964 matched patients without diabetes mellitus (DM) were enrolled between 2000 and 2010. The patients were followed up until death or the end of the study period (31 December 2013). The primary outcome was the occurrence of DNI. Results: Patients with T1DM exhibited a significantly higher cumulative incidence of DNI than did those without DM (p < 0.001). The Cox proportional hazards model showed that T1DM was significantly associated with a higher incidence of DNI (adjusted hazard ratio, 10.71; 95% confidence interval, 6.02–19.05; p < 0.001). The sensitivity test and subgroup analysis revealed a stable effect of T1DM on DNI risk. The therapeutic methods (surgical or nonsurgical) did not differ significantly between the T1DM and non-DM cohorts. Patients with T1DM required significantly longer hospitalization for DNI than did those without DM (9.0 ± 6.2 vs. 4.1 ± 2.0 days, p < 0.001). Furthermore, the patients with T1DM were predisposed to DNI at a younger age than were those without DM. Conclusions: T1DM is an independent risk factor for DNI and is associated with a 10-fold increase in DNI risk. The patients with T1DM require longer hospitalizations for DNI and are younger than those without DM.

Highlights

Deep neck infection (DNI) is a common infectious disease involving the deep neck space; DNI usually requires intensive care and aggressive treatment [1]
The incidence of DNI was significantly higher in the type 1 diabetes mellitus (DM) (T1DM) cohort than in the non-DM cohort (p < 0.001)
The Cox proportional hazards model revealed that T1DM was associated with a 10-fold higher risk of DNI

Summary

Introduction

Deep neck infection (DNI) is a common infectious disease involving the deep neck space; DNI usually requires intensive care and aggressive treatment [1]. A study reported that patients with diabetes mellitus (DM) are at a 1.4-fold higher risk of DNI than those without DM [6]. DNI can cause higher morbidity and mortality among patients with systemic diseases such as DM, end-stage renal disease, liver cirrhosis, and autoimmune diseases [1,4,7,8,9]. Patients with T1DM, considered to have an immunocompromised status, are expected to be more vulnerable to complicated infection and have a higher infection-related mortality risk than patients with T2DM [11]. Studies investigating the effect of T1DM on DNI are not currently available in the literature. This study investigated the effect of T1DM on DNI occurrence, treatment, and prognosis

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