Abstract
BackgroundThe elderly are predisposed to septic arthritis (SA) because of the aging nature and increasing comorbidities. SA may in turn increase the long-term mortality in the geriatric patients; however, it remains unclear. We conducted this prospective nationwide population-based cohort study to clarify this issue.MethodsUsing Taiwan National Health Insurance Research Database (NHIRD), we identified 1667 geriatric participants (≥ 65 years) with SA and 16,670 geriatric participants without SA matched at a ratio of 1:10 by age, sex, and index date between 1999 and 2010. A comparison of the long-term mortality between the two cohorts through follow-up until 2011 was performed.ResultsGeriatric participants with SA had a significantly increased mortality than those without SA [Adjusted hazard ratio (AHR): 1.49, 95% confidence interval (CI): 1.34–1.66], particularly the old elderly (≥ 85 years, AHR: 2.12, 95% CI: 1.58–2.84) and males (AHR: 1.54, 95% CI: 1.33–1.79). These results were stated after adjustment for osteoarthritis, diabetes, gout, renal disease, liver disease, cancer, rheumatoid arthritis, systemic lupus erythematosus, alcoholism, and human immunodeficiency virus infection. The increased mortality risk was highest in the first month (AHR: 3.93, 95% CI: 2.94–5.25) and remained increased even after following up for 2–4 years (AHR: 1.30, 95% CI: 1.03–1.65). After Cox proportional hazard regression analysis, SA (AHR: 1.37, 95% CI: 1.20–1.56), older age (≥ 85 years, AHR: 1.79, 95% CI: 1.59–2.02, 75–84 years, AHR: 1.65, 95% CI: 1.53–1.78), male sex, diabetes, renal disease, liver disease, cancer, and gout were independent mortality predictors. There was no significant difference in the mortality for SA between upper limb affected and lower limb affected.ConclusionsThis study delineated that SA significantly increased the long-term mortality in geriatric participants. For the increasing aging population worldwide, strategies for the prevention and treatment of SA and concomitant control of comorbidities are very important.
Highlights
The elderly are predisposed to septic arthritis (SA) because of the aging nature and increasing comorbidities
This study delineated that SA significantly increased the long-term mortality in geriatric participants
After Cox proportional hazard regression analysis, we found that SA (AHR: 1.23, 95% confidence interval (CI): 1.08–1.40), older age (≥ 85 and 75–84: Adjusted hazard ratio (AHR) 2.18, 95% CI 1.93–2.47, and AHR 1.82, 95% CI 1.68–1.97, respectively), male sex (AHR: 1.23, 95% CI: 1.15–1.33), underlying comorbidities of congestive heart failure (AHR: 1.29, 95% CI: 1.10–1.51), chronic pulmonary obstructive disease (AHR: 1.49, 95% CI: 1.35–1.65), stroke (AHR: 1.66, 95% CI: 1.50–1.84), diabetes (AHR: 1.69, 95% CI: 1.55–1.83), gout (AHR: 1.25, 95% CI: 1.10–1.43), renal disease (AHR: 2.29, 95% CI: 2.00–2.62), liver disease (AHR: 1.51, 95% CI: 1.32–1.73), cancer (AHR: 1.74, 95% CI: 1.51– 2.01), and rheumatoid arthritis (AHR: 1.55, 95% CI: 1.02–2.34) were independent mortality predictors (Table 3)
Summary
The elderly are predisposed to septic arthritis (SA) because of the aging nature and increasing comorbidities. SA may in turn increase the long-term mortality in the geriatric patients; it remains unclear. We conducted this prospective nationwide population-based cohort study to clarify this issue. Aging issues are very important because the elderly (≥ 65 years old) are expected to increase rapidly from 6.2% of the world population in 1992 to 20% by 2050 [1]. The predisposing factors for SA are as follows: (1) age > 80 years; (2) weak immune system due to diabetes, renal, and liver diseases, human immunodeficiency virus (HIV) infection, and use of immune-suppression drugs; (3) alcohol abuse; (4) cancer; (5) rheumatoid arthritis; (6) presence of prosthetic joint; (7) recent joint surgery; (8) skin infection; and (9) prior intra-articular corticosteroid injection [4,5,6]
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