Author: Mark Breazzano (United States)
Co-authors: Adrienne Scott, Fasika Woreta, Loka Thangamathesvaran
Purpose
Endogenous endophthalmitis (EE) is a rare entity with potentially devastating visual consequences from systemic infection. Large-scale analysis is scant regarding predictors of systemic outcomes for patients specifically with EE. The goal of this study is to characterize incidence rates and identify risk factors for admission and mortality with EE in the United States (US).
Setting/Venue
A nationwide, retrospective cohort study was conducted from the National Emergency Department Sample. Study participants received care at any US emergency department (ED) between 2006–2017.
Methods
Patients with EE were identified by requiring diagnoses of both endophthalmitis and septicemia using contemporary International Classification of Diseases diagnosis codes. Main outcome measures were nationwide EE incidence rates and risk factors for admission and mortality.
Results
A total of 6,400 patients with EE were identified. Incidence increased from 0.10 (95% confidence interval [CI]: 0.07-0.12) per 100,000 in the US civilian population in 2006 to 0.25 (95%CI: 0.21-0.30) in 2017 (p<0.05). Most were female (55.4%), insured with Medicare (53.5%), had first income quartile earnings (29.3%) [bottom 25% income bracket], lived in South (40.5%), and presented to metropolitan teaching hospital (66.6%) (p<0.05). Mortality increased from 8.6% (95%CI: 3.8%-18.3%) in 2006 to 13.8% (95%CI: 9.7%-19.2%) in 2017 (p=0.94). Factors predicting admission included older age (odds ratio [OR] 32.59; [95%CI 2.95-359.78]) and intravenous drug use (OR 14.90 [95%CI: 1.67-133.16]). Factors associated with increased mortality included: human immunodeficiency virus infection/immune deficiencies (OR 2.58 [95%CI: 1.26-5.28]), heart failure (OR 2.12 [95%CI: 1.47-3.05]), and hepatic infections/cirrhosis (OR 1.89 [95%CI: 1.28-2.79]. Pneumonia, renal/urinary tract infections (UTI) were associated with both increased hospital admission [(pneumonia OR 9.64 (95%CI: 1.25-74.35, p=0.030), renal/UTI OR 4.09 (95%CI 1.77-9.48)] and mortality [(pneumonia OR 1.64 (95%CI: 1.17-2.29, p=0.030), renal/UTI OR 1.87 (95%CI 1.18-2.97)]. Patients with type 2 diabetes mellitus (DM) had decreased odds ratio for mortality (OR 0.49 [95%CI: 0.33-3.73]).
Conlusions
EE has increased in incidence throughout US. The two systemic factors that conferred both an increase in mortality and admission were pneumonia, and renal/UTI. Additional exploration of the potential protective association of DM with decreased mortality in this context is needed.
Financial Disclosure
Ophthalmology Times (Honorarium), techspert.io (Ad Hoc Consultant)
Comments
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