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Increased risk of non-multiple sclerosis demyelinating syndromes in patients with preexisting septicaemia: a nationwide retrospective cohort study
  1. Chung-Hsing Chou1,2,
  2. Jiunn-Tay Lee1,2,
  3. Chia-Kuang Tsai1,2,
  4. Li-Ming Lien3,4,
  5. Jiu-Haw Yin1,5,
  6. Chun-Chieh Lin1,
  7. I-Ju Tsai6,
  8. Yueh-Feng Sung1,
  9. Fu-Chi Yang1,
  10. Chia-Lin Tsai1,
  11. I-Kuan Wang7,8,9,
  12. Chun-Hung Tseng10,
  13. Chung-Y Hsu7
  1. 1 Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republicof China
  2. 2 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
  3. 3 Department of Neurology, Shin-Kong WHS Memorial Hospital, Taipei, Taiwan, Republic of China
  4. 4 School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
  5. 5 Division of Neurology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
  6. 6 Management Office for Health Data, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
  7. 7 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, Republic of China
  8. 8 Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
  9. 9 Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan, Republic of China
  10. 10 Department of Neurology, China Medical University Hospital, Taichung, Taiwan, Republic of China
  1. Correspondence to Jiunn-Tay Lee, Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taipei, Taiwan, Republic of China; jiunntay{at}gmail.com

Abstract

Background Growing evidence shows links between septicaemia and non-multiple sclerosis demyelinating syndromes (NMSDS); nevertheless, epidemiological data are still very limited. This study aimed to explore the relationship between septicaemia and NMSDS in a general population.

Methods The study included 482 781 individuals diagnosed with septicaemia and 1 892 825 age/sex-matched non-septicaemia patients for the comparison. Data were drawn from a population-based nationwide National Health Insurance Research Database Taiwan, from 1 January 2002 to 31 December 2011. The two cohorts of patients with and without septicaemia were followed up for the occurrence of NMSDS. The Cox-proportional hazard regression model was performed to estimate adjusted HR after multivariate adjustment.

Results Individuals with septicaemia had a 4.17-fold (95% CI 3.21 to 5.4, p < 0.001) higher risk to develop NMSDS compared with those without septicaemia. Patients aged <65 years had a greater NMSDS risk (<45 years: HR = 6.41, 95% CI 3.65 to 11.3, p < 0.001; 45–64 years: HR = 6.66, 95% CI 3.98 to 11.2, p < 0.001). Furthermore, females with septicaemia and individuals with higher severity of septicaemia were associated with increased risks of developing NMSDS.

Conclusions Our results indicated that patients with septicaemia were likely to develop NMSDS. A possible contributing role of septicaemia in increasing the hazard of NMSDS is proposed, based on the outcome that individuals with higher severity of septicaemia carried elevated threat of encountering NMSDS.

  • septicaemia
  • transverse myelitis
  • acute disseminated encephalomyelitis
  • demyelination

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors Study concept/design: CHC, CKT and JTL; data collection and analysis: CHC, CKT, JTL, IJT, IKW, CHT and CYH; data interpretation: CHC, CKT, LML, JTL, JHY, CCL, YFS, FCY and CLT; manuscript writing: CHC, CKT and JTL. All authors have given their final approval of the version to be published.

  • Funding This work was supported in part by grants from the Ministry of Science and Technology (MOST 106-2314-B-016-010, MOST 105-2314-B-016-004 and MOST 106-2314-B-016-007-MY2), Ministry of National Defense Medical Affairs Bureau (MAB-106-041 and MAB-106-044), Tri-Service General Hospital (TSGH-C105-082, TSGH-C107-073, TSGH-C106-068, TSGH-C107-072, TSGH-C107-074 and TSGH-C108-006-007-007-S05), Cheng Hsin General Hospital (CH-NDMC-106-13), the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-212-123004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10701010021), Taiwan Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

  • Competing interests No, there are no competing interests for any author.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available in a public, open access repository. There are no data in this work. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.

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