title: Risk of liver cirrhosis in patients with tuberculosis: a nationwide cohort study.
abstract: BACKGROUND
  Most of the previous reports found cirrhosis patients with a high risk of subsequent tuberculosis (TB). However, data about the risk of developing liver cirrhosis in TB patients are limited. As a hepatitis endemic area, the risk of liver cirrhosis in patients with TB should be elucidated in Taiwan.
  
  
  METHODS
  We conducted the study using Taiwan's National Health Insurance Research Database. Patients with TB (n = 9339) were identified as the TB cohort and matched with a control (n = 37 356). Each study participant was followed until diagnosis of liver cirrhosis, loss of follow-up, death, withdrawal from the insurance or until 31 December 2011.
  
  
  RESULTS
  A cumulative incidence of liver cirrhosis in the TB cohort had a significantly higher risk for liver cirrhosis compared with the control (log-rank test, P < 0·001). The overall incidence of liver cirrhosis was significantly higher in the TB group than in controls [3·83 vs. 2·02 per 1000 person-year; crude hazard ratio (HR) = 1·88; 95% confidence interval (CI) = 1·59-2·23]. After controlling for age, gender and comorbidities, the risk was 1·79-fold (95% CI = 1·50-2·14) higher in the TB group than in the controls. Analysis by Cox proportional hazard regression revealed that TB increased the risk of cirrhosis in patients with either hepatitis B (adjusted HR = 1·91; 95% CI = 1·05-3·47) or hepatitis C (adjusted HR = 2·56; 95% CI = 1·37-4·78).
  
  
  CONCLUSIONS
  An increased incidence of liver cirrhosis was observed among TB patients in Taiwan.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yen-Chun
authors.initials: YC
authors.lastname: Peng
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Wan-Yun
authors.initials: WY
authors.lastname: Hsu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chi-Sen
authors.initials: CS
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hong-Zen
authors.initials: HZ
authors.lastname: Yeh
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007182:Income; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology*; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Liver cirrhosis; Taiwan National Health Insurance Research Database; retrospective nationwide cohort study; tuberculosis