Diabetes risk in patients with chronic obstructive pulmonary disease: a retrospective cohort study

( Yi-chun Chou ),( Ta-liang Chen ),( Chien-chang Liao ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: The relationship between chronic obstructive pulmonary disease (COPD) and diabetes remains incompletely understood. This study evaluated the risk of diabetes in COPD patients with and without exacerbations. Methods: We identified 4671 adults newly diagnosed with COPD exacerbations and 9342 adults newly diagnosed with COPD without exacerbations during 2000-2008 using Taiwan’s National Health Insurance Research Database. A comparison cohort of 18684 adults without COPD, matched by age and sex, was randomly selected from the same dataset for the control group. Diabetes events during 2000-2013 were ascertained from medical claims during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with COPD with or without exacerbations were calculated. Results: During the follow-up period, the incidences of diabetes for patients without COPD and for patients with COPD without or with exacerbations were 3.4, 4.1 and 7.4 per 1000 person-years, respectively (P < 0.0001). Increased risk of diabetes for patients with COPD without exacerbations (HR 1.09, 95% CI 1.02-1.17) and COPD with exacerbations (HR 2.18, 95% CI 1.88-2.52) was noted. The associaiton between COPD and diabetes risk was significant in various subgroups. Conclusion: Prevention and intervention strategies for diabetes risk is needed for this susceptible population.

Outcomes after Admission of Liver Disease in Patients with Influenza Vaccination: A Nationwide Study

( Yi-chun Chou ),( Chien-chang Liao ),( Ta-liang Chen ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: The influences of influenza vaccination (IV) on outcomes of admission of liver disease are unclear. The purpose of this study is to investigate IV’s effects on pneumonia and mortality after liver disease in geriatric patients. Methods: Using Taiwan’s National Health Insurance Research Database reimbursement claims data from 2008 to 2013, we conducted a retrospective cohort study of 21385 patients aged more than 66 years who admitted to hospitalization due to liver disease (included viral hepatitis, cancer, necrosis of liver, and chronic liver disease) and 21035 had IV before the admission within one year. Multivariate logistic regressions were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of post-admission pneumonia and in-hospital mortality associated with IV. Results: Patients receiving IV showed less pneumonia after liver disease (OR 0.51, 95% CI 0.35-0.75). But there was no significant association between IV and in-hospital mortality (OR 0.85, 95% CI 0.46-1.56) compared with unvaccinated patients. Conclusions: Vaccinated geriatric patients showed lower risks of pneumonia compared with unvaccinated patients undergoing similar admission of liver disease. Further studies are needed to explain how IV improves the outcomes of liver disease.

Protective Effects of Influenza Vaccination on the Admission Outcomes of Liver Cancer: A Nationwide Matched Study

( Yi-chun Chou ),( Ta-liang Chen ),( Chien-chang Liao ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Limited information is available on the association between influenza vaccination (IV) and cancer outcomes. The purpose of this study is to evaluate the effects of IV on the out comes of liver cancer. Methods: Using reimbursement claims data of National Health Insurance in Taiwan in 2008-2013, we conducted a matched cohort study including 32330 patients aged ≥20 years underwent inpatient care of liver cancer and 5841 of them received IV within previous one year. Using propensity score matching procedure, we selected 5621 patients with IV and 5621 patients without IV for comparison. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of IV associated with complications and in-hospital mortality during admission of liver cancer. Results: Patients with liver cancer receiving IV showed less pneumonia (P<0.0001), septicemia (P<0.0001), urinary tract infection (P<0.0001), and in-hospital mortality (P<0.0001) compared with unvaccinated patients with liver cancer. IV was associated with decreased risk of in-hospital mortality during the cancer admission (OR, 0.60; 95% CI, 0.47-0.76) after adjustment. Vaccinated patients with liver cancer also had shorter length of hospital stay (P<0.0001) and lower medical expenditure (P<0.0001) than non-vaccinated patients. Conclusions: Among patients with admission of liver cancer, vaccinated patients showed lower risks of complications and in-hospital mortality compared with unvaccinated patients. Further studies are needed to explain how IV improves outcomes of liver cancer.

Poster Session : PS 0318 ; Hematology : Increased Mortality after Stroke in Patients with Immune Thrombocytopenia: A Nationwide Population- Based Study

( Chien Chang Liao ),( Ta Liang Chen ),( Chun Chuan Shih ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Limited information was available on the outcomes after stroke in patients with immune thrombocytopenia (ITP). This study evaluated the adverse events after stroke in patients with ITP. Methods: From the claims data of National Health Insurance Database, we conducted a nationwide retrospective cohort study consisted of 2183 stroke patients with ITP between 2002 and 2009. Using matching procedure by propensity score with age, sex, low income, urbanization, teaching hospital, diabetes, hypertension, hyperlipidemia, myocardial infarction, mental disorders, liver cirrhosis, dementia, renal dialysis, anticoagulants, anti-platelet agents, lipid-lowering agents, and types of stroke, we selected 21830 non-ITP patients with stroke during the index date for comparison. Results: After adjustment for sociodemographics, coexisting medical conditions, medications, and types of stroke in the multivariate logistic regressions, patients with ITP had higher 30-day mortality after stroke compared with stroke patients without ITP (odds ratio=1. 41, 95% confi dence interval=1. 15-1. 74). ITP was also associated withincreased medical expenditure after stroke (odds ratio=1. 13, 95% confi dence interval= 1. 01-1. 27). Conclusions: Our nationwide retrospective cohort study investigated the increased risk of mortality after stroke in patients with ITP.

Modifi ed Radiology-Guided Percutaneous Gastrostomy (MRPG) for Patients with Complete Obstruction of the Upper Digestive Tract and Who are without Endoscopic or Nasogastric Access

Siu-Cheung Chan,Winnie Chiu-Wing Chu,Kar-Wai Liu,Chun-Ta Liao,Tsung-Shih Lee,Shu-Hang Ng 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.2

Objective: We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. Materials and Methods: Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fl uoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fl uoroscopic guidance) was performed in these patients. Results: We achieved successfully percutaneous gastrostomy using the modifi ed technique in all patients without any major or minor complications after the procedure. Conclusion: A modifi ed radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract. Objective: We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. Materials and Methods: Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fl uoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fl uoroscopic guidance) was performed in these patients. Results: We achieved successfully percutaneous gastrostomy using the modifi ed technique in all patients without any major or minor complications after the procedure. Conclusion: A modifi ed radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.