Risk of stroke following diagnosis with pyogenic liver abscess: a nationwide population-based study

Abstract

In the recent years, the mortality rates attributed to pyogenic liver abscess (PLA) have decreased substantially on account of advancements in antibiotics and surgical techniques. It is thus important to better understand the risks associated with the increased number of survivors. This population-based study was designed to estimate the risk of stroke during a 1year period following diagnosis with PLA, compared to individuals who did not suffer from PLA. Data were obtained from the Taiwan National Health Insurance Research Database. A total of 9,977 patients receiving ambulatory with a diagnosis of PLA were included, together with 49,885 non-PLA patients as our comparison group. Each individual was followed for 1year, with check-ups at 30days, 90days, and 1year post diagnosis to identify the subsequent occurrence of stroke. Cox proportional hazards regressions were performed for the analysis. During the 1year follow-up period, 475 (4.76%) strokes occurred among the PLA patients and 1,713 (3.43%) patients in the non-PLA comparison cohort. The diagnosis of PLA was independently associated with 1.99 (95% confidence interval (CI) 1.68-2.34), 1.72 (95% CI 1.52-1.97), and 1.43 (95% CI 1.28-1.59) times greater risks of stroke during the 30days, 90days, and 1year follow-up periods, respectively, after adjusting for urbanization level, geographic region, monthly income, hypertension, diabetes, coronary heart diseases, renal diseases, heart failure, hyperlipidemia, atrial fibrillation, obesity, and alcohol abuse/alcohol-dependence syndrome. We suggest a need for more intensive medical monitoring following PLA infection, especially during the first few months. However, data regarding smoking were unavailable in our dataset and may have biased our findings.