title: Risk of empyema in patients with chronic liver disease and cirrhosis: A nationwide, population-based cohort study.
abstract: Empyema is an important complication for patients with chronic liver disease and cirrhosis (CLDC). However, no study has investigated this relationship by using a population-based cohort study.
  
  
  
  We used the National Health Insurance Research Data of Taiwan to identify a cohort of 76 027 CLDC patients newly diagnosed in 2000-2010 and a comparison cohort without CLDC of same size matched by age, gender and the year of diagnosis. The occurrence of empyema was monitored until the end of 2011. The hazard ratios (HRs) of empyema were estimated using the Cox model.
  
  
  
  The overall incidence of empyema was 66% greater in the CLDC group than in the non-CLDC group (3.85 vs 2.32/10 000 person-years, P<.001), with an adjusted HR of 1.54 (95% confidence interval [CI]=1.24-1.90). Compared with those without CLDC, adjusted HRs of empyema were 4.96 (95% CI=3.40-7.24) for patients with cirrhosis and 4.75 (95% CI=3.11-7.24) for patients with alcoholic CLDC. Further analyses revealed significant adjusted HRs of empyema among CLDC patients with ascites (5.76, 95% CI=4.13-8.04) and with gastrointestinal haemorrhage (1.60, 95% CI=1.03-2.48), compared to those without the respective disorders. Analyses using propensity score matched CLDC and non-CLDC cohorts revealed similar results.
  
  
  
  The present study shows that CLDC patients have an increased risk of empyema. These patients need timely monitor for the risk of empyema, particularly for those with comorbid cirrhosis, alcoholic disorder, gastrointestinal haemorrhage and ascites.
authors.affiliation: Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan.|Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Te-Chun
authors.identifier: 0000-0002-9427-1068
authors.initials: TC
authors.lastname: Shen
authors.affiliation: Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan.|Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsueh-Chou
authors.initials: HC
authors.lastname: Lai
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: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsia
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chuen-Ming
authors.initials: CM
authors.lastname: Shih
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wu-Huei
authors.initials: WH
authors.lastname: Hsu
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|Department of Health Services Administration, China Medical University, Taichung, Taiwan.|Mahidol University Faculty of Public Health, Bangkok, Thailand.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D004653:Empyema / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology*; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: ascites; chronic liver disease; cirrhosis; empyema