Abstract
BackgroundShort-term mortality and incidence of cerebrovascular and cardiovascular events (C-CVE) during hospitalization of patients with severe herpes zoster (HZ) have not been sufficiently investigated. We aimed to investigate short-term prognosis and incidence of C-CVE associated with HZ in hospitalized patients.MethodsThis retrospective cohort study from April 2016 to March 2018 included HZ inpatient cases selected from the Diagnosis Procedure Combination database—a Japanese nationwide inpatient database. HZ and C-CVE were diagnosed based on the 10th revision of the International Classification of Diseases and Injuries codes. The definition of primary exposure was that treatments were initiated within 7 days of admission, and antivirals were administered for ≥7 days. Main Outcomes were in-hospital deaths and C-CVE onset after hospitalization.ResultsAmong 16,811,501 in-hospital cases registered from 1,208 hospitals, 29,054 cases with HZ were enrolled. The median age was 71.0 years, 15,202 cases (52.3%) were female, and the HZ types were the central nervous system (n=9,034), disseminated (n=3,051), and ophthalmicus (n=1,069) types. There were 301 (1.0%) in-hospital deaths and 385 (1.3%) post-hospitalization onset of C-CVE. The 30-day in-hospital survival rates with or without underlying disease were 96.8% and 98.5%, respectively. Age ≥75 years (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.55–3.05), liver cirrhosis or hepatic failure (HR, 5.93; 95% CI, 2.16–16.27), chronic kidney disease (HR, 1.82; 95% CI, 1.24–2.68), heart failure (HR, 1.65; 95% CI, 1.22–2.24), and old cerebrovascular events (HR, 1.92; 95% CI, 1.10–3.34) were associated with poor short-term prognosis. Age ≥75 years (odds ratio [OR], 1.70; 95% CI, 1.29–2.24), diabetes (OR, 1.50; 95% CI, 1.19–1.89), dyslipidemia (OR, 1.95; 95% CI, 1.51–2.51), hyperuricemia (OR, 1.63; 95% CI, 1.18–2.27), hypertension (OR, 1.76; 95% CI, 1.40–2.20), heart failure (OR, 1.84; 95% CI, 1.32–2.55), and glucocorticoid administration (OR, 1.59; 95% CI, 1.25–2.01) were associated with increased risks for in-hospital C-CVE onset.ConclusionsThe underlying diseases that could influence the short-term mortality of severe HZ were identified. Glucocorticoid is a possible risk factor for the in-hospital onset of C-CVE after severe HZ development.
Highlights
Herpes zoster (HZ) is an infection caused by the varicellazoster virus (VZV)
The incidence of HZ is higher in Japanese rheumatoid arthritis (RA) patients treated with a Janus kinase inhibitor (JAK-i), and the reasons have received attention [9, 10]
There have been a few studies that have focused on patients hospitalized with severe HZ, which increases the incidence of death or cardiovascular events (C-CVE) onset, and there is a paucity of studies that have examined shortterm prognostic factors, the frequency of HZ-related C-CVE during hospitalization, and risk factors for developing C-CVE
Summary
Herpes zoster (HZ) is an infection caused by the varicellazoster virus (VZV). The risk of onset and severity increases in the elderly and in patients with underlying diseases that can lead to immunosuppression, such as connective tissue diseases (CTD) and malignancies [1–5]. HZ is caused by various complications, including cerebrovascular and cardiovascular events (C-CVE) such as stroke and ischemic heart disease (IHD) [13]. There have been a few studies that have focused on patients hospitalized with severe HZ, which increases the incidence of death or C-CVE onset, and there is a paucity of studies that have examined shortterm prognostic factors, the frequency of HZ-related C-CVE during hospitalization, and risk factors for developing C-CVE. We focused on patients with severe HZ that required hospitalization and investigated the shortterm prognosis and prognostic factors and the incidence of CCVE onset and risk factors of C-CVE onset after hospitalization for HZ treatment using the national administrative inpatient database in Japan. Short-term mortality and incidence of cerebrovascular and cardiovascular events (C-CVE) during hospitalization of patients with severe herpes zoster (HZ) have not been sufficiently investigated. We aimed to investigate short-term prognosis and incidence of C-CVE associated with HZ in hospitalized patients
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