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Association of scrub typhus with the risk of venous thromboembolism and long-term mortality: a population-based cohort study

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Abstract

Background

The existing literature lacks studies examining the epidemiological link between scrub typhus and deep vein thrombosis (DVT) or pulmonary embolism (PE), and the long-term outcomes. The objective of this study is to explore the potential association between scrub typhus and the subsequent risk of venous thromboembolism, and long-term mortality.

Method

This nationwide cohort study identified 10,121 patients who were newly diagnosed with scrub typhus. Patients with a prior DVT or PE diagnosis before the scrub typhus infection were excluded. A comparison cohort of 101,210 patients was established from the general population using a propensity score matching technique. The cumulative survival HRs for the two cohorts were calculated by the Cox proportional hazards model.

Result

After adjusting for sex, age, and comorbidities, the scrub typhus group had an adjusted HR (95% CI) of 1.02 (0.80–1.30) for DVT, 1.11 (0.63–1.93) for PE, and 1.16 (1.08–1.25) for mortality compared to the control group. The post hoc subgroup analysis revealed that individuals younger than 55 years with a prior scrub typhus infection had a significantly higher risk of DVT (HR: 1.59; 95% CI: 1.12–2.25) and long-term mortality (HR: 1.75; 95% CI, 1.54–1.99).

Conclusion

The scrub typhus patients showed a 16% higher risk of long-term mortality. For those in scrub typhus cohort below 55 years of age, the risk of developing DVT was 1.59 times higher, and the risk of mortality was 1.75 times higher. Age acted as an effect modifier influencing the relationship between scrub typhus and risk of new-onset DVT and death.

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Data availability

Data are available from the National Health Insurance Research Database (NHIRD). Due to legal restrictions imposed by the government of Taiwan regarding the “Personal Information Protection Act”, data sets are not publicly available. Requests for data can be sent as a formal proposal to the NHIRD (http://nhird.nhri.org.tw).

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Acknowledgements

We are grateful to the Health Data Science Center at the China Medical University Hospital for providing administrative, technical, and funding support. We would like to thank China Medical University, Taiwan (CMU110-MF-115 and CMU111-MF-105), and the Ministry of Science and Technology, Taiwan (MOST 111-2410-H-039-002-MY3) for supporting this publication. The funding entities had no role in the study design, data collection, data analysis, interpretation, or authorship of the manuscript.

Funding

This study was supported by funding from the China Medical University (CMU111-MF-105) and the Ministry of Science and Technology, Taiwan (MOST 109-2410-H-039-002, MOST 110-2410-H-039-002, MOST 111-2410-H-039-002-MY3).

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Authors and Affiliations

  1. Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813, Taiwan

    En-Shao Liu, Yi-Ting Wu & Feng-Yu Kuo

  2. Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    En-Shao Liu

  3. Department of Health Services Administration, China Medical University, Taichung, Taiwan

    Wen-Miin Liang

  4. Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan

    Feng-Yu Kuo

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Correspondence to Feng-Yu Kuo.

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The study protocol was reviewed and approved by the Institutional Review Board (IRB) of China Medical University Hospital (certificate: CMUH107-REC3-074 (CR-3)).

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Liu, ES., Wu, YT., Liang, WM. et al. Association of scrub typhus with the risk of venous thromboembolism and long-term mortality: a population-based cohort study. Eur J Clin Microbiol Infect Dis (2024). https://doi.org/10.1007/s10096-024-04793-z

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