Risk Factors and 30-day Mortality of Patients With Herpes Esophagitis: A 10-year Experience of 47 Cases at a Single Center

Abstract

Esophageal infections are rare in immunocompetent individuals but common in immunosuppressed patients, particularly in patients with end-stage renal disease, malignancy, transplanted organs, and human immunodeficiency virus (HIV) and in those undergoing immunosuppressive therapy. The most commonly affected part of the alimentary tract for herpes simplex virus (HSV) is the esophagus, with an incidence of 0.5-2% based on an autopsy series. We aimed to investigate the clinical characteristics, risks and outcome of patients with herpes esophagitis (HE). From 2003 to 2013, 47 patients with HE were identified histologically from among 1843 patients with esophageal ulcers. Several variables, including age, sex, underlying diseases, smoking, alcohol, and so on, were analyzed with the chi-squared test to determine potential risk factors for HE. Kaplan-Meier estimate to evaluate importance of clinical risk factors for the clinical outcome of HE. A two-sided p-value < 0.05 was considered significant for all statistical tests. The mean age of patients was 62.04 ± 14.76 years, and most patients were men (39/47, 83%). Twenty-five of 47 patients (53.2%) were diagnosed with malignancy. Patients with malignancy had undergone chemotherapy (24%), radiotherapy (12%), and concurrent chemoradiotherapy (CCRT) (28%). Kaplan–Meier estimates of 30-day mortality rate after appearance of herpes esophagitis (HE) stratified by white blood cell count (WBC) (/mm3) (P = 0.627), endoscopic typing of HE (P = 0.520), malignancy (P = 0.097), chemotherapy and/or radiotherapy (P = 0.018), age > 60 y/o (P = 0.129) and usage of anti-HSV agent (P = 0.221). Only the factor of receiving chemotherapy and/or radiotherapy for clinical outcome revealed significant difference (p < 0.05). In conclusion, HE primarily affects men and patients with malignancy. Patients with malignancy who receiving chemotherapy and/or radiotherapy are at increased risk of death within 30 days (17.6% [3/17]) after appearance of herpes esophagitis compared to patients without immunosuppressive therapy.