title: Increased occurrence of native septic arthritis in adult cirrhotic patients: a population-based three-year follow-up study in Taiwan.
abstract: BACKGROUND
  Due to impairment of immunity and metabolism, cirrhotic patients are prone to infection, osteoporosis, and osteonecrosis. However, it is unknown if cirrhotic patients are prone to native septic arthritis (NSA).
  
  
  OBJECTIVE
  To assess the occurrence of NSA between cirrhotic and non-cirrhotic patients.
  
  
  METHODS
  We used the Taiwan National Health Insurance Database to enrol 35,106 cirrhotic patients and 33,457 non-cirrhotic patients from January 1, 2004 to December 31, 2004. The medical record of each patient was individually followed for a 3-year period.
  
  
  RESULTS
  There were 341 (0.5%) patients having NSA in a follow-up period of 3 years: 214 cirrhotic and 127 non-cirrhotic patients. The incidence density of hospitalisation for NSA was 2.03 episodes/1000 person-years in cirrhotic patients, and 1.27 episodes/1000 person-years in non-cirrhotic patients. After adjustment for age, gender, and other comorbid disorders, Cox's regression analysis showed that cirrhotic patients had a higher occurrence of NSA than non-cirrhotic patients(hazard ratio (HR) = 1.51, 95% confidence interval (CI) = 1.19-1.90; p = 0.001). The patients with complicated cirrhosis were more prone to have NSA than those with non-complicated cirrhosis (HR = 1.46, 95% CI = 1.09-1.96, p = 0.011).
  
  
  CONCLUSIONS
  This analysis demonstrates that cirrhotic patients have a higher risk of NSA, particularly those with complicated cirrhosis.
authors: Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan ; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors: Tsung-Hsing
authors: TH
authors: Hung
authors: Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
authors: Min-Hong
authors: MH
authors: Hsieh
authors: School of Medicine, Tzu Chi University, Hualien, Taiwan ; Division of Infectious diseases, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
authors: Chorng-Jang
authors: CJ
authors: Lay
authors: Department of Mathematics, Tamkang University, New Taipei City, Taiwan.
authors: Chih-Chun
authors: CC
authors: Tsai
authors: School of Medicine, Tzu Chi University, Hualien, Taiwan ; Division of Infectious diseases, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
authors: Chen-Chi
authors: CC
authors: Tsai
keywords: arthritis; cirrhosis; septic arthritis
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