End-stage renal disease as a risk factor for epiglottitis: A population-based cohort study in Taiwan

Yao Te Tsai*, Ming Shao Tsai, Cheng Ming Hsu, Ku Hao Fang, Ethan I. Huang, Chia Yen Liu, Meng Hung Lin, Yao Hsu Yang, Yi Chan Lee, Geng He Chang

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

2 Scopus citations


Objectives Patients with uremia are prone to infection; however, end-stage renal disease (ESRD) as a risk factor for acute epiglottitis warrants study. We investigated the risk of severe epiglottitis requiring hospitalisation in patients with ESRD. Setting We conducted a retrospective matched cohort study by using the claims data of Taiwan's National Health Insurance Research Database. Participants We identified an ESRD cohort with 87 908 patients newly diagnosed in 2000-2013 and underwent dialysis. The non-ESRD cohort comprised patients who had not received a diagnosis of ESRD, and they were matches to the ESRD cohort (1:1) by sex, age, residence urbanisation level, monthly income, and diabetes and hypertension status. Primary and secondary outcome measures The cumulative incidence of epiglottitis at the end of 2013 was analysed with Kaplan-Meier methods and log-rank tests. The HR of epiglottitis was calculated using the Cox proportional hazards model after adjustment for confounding factors. Results The overall epiglottitis incidence rate was 94% greater in the ESRD cohort than in the non-ESRD cohort (10.3 vs 5.3 cases per 100 000 person-years, p=0.002), with an adjusted HR of 1.89 (95% CI: 1.23 to 2.91, p=0.004). In the log-rank analysis, compared with the non-ESRD group, the epiglottitis cumulative incidence was significantly higher in the ESRD group (p=0.003). Epiglottitis did not exhibit an association with higher rates of airway interventions, intensive care unit admissions or longer hospitalisation in patients with ESRD than in controls. Conclusions This nationwide matched cohort study indicated that ESRD patients should be monitored for the risk of severe epiglottitis requiring hospitalisation.

Original languageEnglish
Article numbere038683
JournalBMJ Open
Issue number11
StatePublished - 03 11 2020
Externally publishedYes

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  • adult otolaryngology
  • end stage renal failure
  • laryngology


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