Risk of pleural empyema in patients with schizophrenia: a nationwide propensity-matched cohort study in Taiwan

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Abstract

Objective

Thoracic infection and pneumonia are prevalent in patients with schizophrenia; however, it is unclear whether patients with schizophrenia are at an increased risk of developing pleural empyema.

Design

A retrospective cohort study with propensity-matched cohorts with and without schizophrenia.

Setting

Using the National Health Insurance Research Database of Taiwan.

Participants

We identified 55 888 patients with schizophrenia newly diagnosed in 2000–2011 and same number of individuals without schizophrenia as the comparison cohort, frequency matched by propensity scores estimated using age, sex, occupation, income, urbanisation, year of diagnosis and comorbidities.

Primary outcome measures

We assessed incident pleural empyema by the end of 2011 and used the Cox proportional hazards model to calculate the schizophrenia cohort to comparison cohort HR of pleural empyema.

Results

The overall incidence of pleural empyema was 2.44-fold greater in the schizophrenia cohort than in the comparison cohort (4.39vs1.80 per 10 000 person-years), with an adjusted HR of 2.87(95% CI 2.14 to 3.84). Stratified analyses by age, sex, occupation, income, urbanisation and comorbidity revealed significant hazards for pleural empyema associated with schizophrenia in all subgroups.

Conclusions

Patients with schizophrenia are at an increased risk of developing pleural empyema and require greater attention and appropriate support.

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Most cited references 24

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Nationwide Population Science: Lessons From the Taiwan National Health Insurance Research Database.

Ann W Hsing, John Ioannidis (2015)

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Parapneumonic effusions and empyema.

Richard Light (2005)

Parapneumonic effusions occur in 20 to 40% of patients who are hospitalized with pneumonia. The mortality rate in patients with a parapneumonic effusion is higher than that in patients with pneumonia without a parapneumonic effusion. Some of the excess mortality is due to mismanagement of the parapneumonic effusion. Characteristics of patients that indicate that an invasive procedure will be necessary for its resolution include the following: an effusion occupying more than 50% of the hemithorax or one that is loculated; a positive Gram stain or culture of the pleural fluid; and a purulent pleural fluid that has a pH below 7.20 or a glucose below 60, or has a lactic acid dehydrogenase level of more than three times the upper normal limit for serum. Patients with pneumonia and an effusion of more than minimal size should have a therapeutic thoracentesis. If the fluid cannot be removed with a therapeutic thoracentesis, a chest tube should be inserted and consideration be given to the intrapleural instillation of fibrinolytics. If the loculated effusion persists, the patient should be subjected to video-assisted thoracoscopic surgery, and if the lung cannot be expanded with this procedure, a full thoracotomy with decortication should be performed. The definitive procedure should be performed within 14 d.

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Second-generation antipsychotic medications and risk of pneumonia in schizophrenia.

Mu-Tung Chang, Chiao-en Chen, Shang-Ying M Tsai … (2013)

This study assessed the association between second-generation antipsychotic medications and risk of pneumonia requiring hospitalization in patients with schizophrenia because the evidence is limited in the population. We enrolled a nationwide cohort of 33,024 inpatients with schizophrenia ranged in age from 18 to 65 years, who were derived from the National Health Insurance Research Database in Taiwan from 2000 to 2008. Cases (n = 1741) were defined as patients who developed pneumonia after their first psychiatric admissions. Risk set sampling was used to match each case with 4 controls by age, sex, and the year of the first admission based on nested case-control study. Antipsychotic exposure was categorized by type, duration, and daily dose, and the association between exposure and pneumonia was assessed using conditional logistic regression. We found that current use of clozapine (adjusted risk ratio = 3.18, 95% CI: 2.62-3.86, P < .001) was associated with a dose-dependent increase in the risk. Although quetiapine, olanzapine, zotepine, and risperidone were associated with increased risk, there was no clear dose-dependent relationship. Amisulpride was associated with a low risk of pneumonia. The use of clozapine combined with another drug (olanzapine, quetiapine, zotepine, risperidone, or amisulpride), as assessed separately, was associated with increased risk for pneumonia. In addition, with the exception of amisulpride, each drug was associated with increased risk for pneumonia at the beginning of treatment. Clinicians who prescribe clozapine to patients with schizophrenia should closely monitor them for pneumonia, particularly at the start of therapy and when clozapine is combined with other antipsychotics.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2018

Publication date (Electronic): 6 July 2018

Volume: 8

Issue: 7

Electronic Location Identifier: e021187

Affiliations

[1 ] departmentDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine , China Medical University Hospital , Taichung, Taiwan

[2 ] departmentIntensive Care Unit , Chu Shang Show Chwan Hospital , Nantou, Taiwan

[3 ] departmentDepartment of Psychiatry , China Medical University Hospital , Taichung, Taiwan

[4 ] Management Office for Health Data, China Medical University Hospital , Taichung, Taiwan

[5 ] departmentDepartment of Business Administration , Asia University , Taichung, Taiwan

[6 ] departmentSchool of Medicine , China Medical University , Taichung, Taiwan

[7 ] departmentDepartment of Health Services Administration , College of Public Health, China Medical University , Taichung, Taiwan

Author notes

[Correspondence to ] Professor Fung-Chang Sung; fcsung1008@ 123456yahoo.com

Author information

Te-Chun Shen http://orcid.org/0000-0002-9427-1068

Article

Publisher ID: bmjopen-2017-021187

DOI: 10.1136/bmjopen-2017-021187

PMC ID: 6042618

PubMed ID: 29982211

SO-VID: adb8d14d-adb8-415f-b537-4f74c8c2c638

License:

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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 15 December 2017

Date revision received : 30 April 2018

Date accepted : 14 May 2018

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ScienceOpen disciplines: Medicine

Keywords: schizophrenia,pleural empyema,retrospective cohort study,propensity score matched

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ScienceOpen disciplines: Medicine

Keywords: schizophrenia, pleural empyema, retrospective cohort study, propensity score matched

Risk of pleural empyema in patients with schizophrenia: a nationwide propensity-matched cohort study in Taiwan

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Abstract

Objective

Design

Setting

Participants

Primary outcome measures

Results

Conclusions

Related collections

25th European Students' Conference

Most cited references 24

Nationwide Population Science: Lessons From the Taiwan National Health Insurance Research Database.

Parapneumonic effusions and empyema.

Second-generation antipsychotic medications and risk of pneumonia in schizophrenia.

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Author notes

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