TY - JOUR
T1 - Long-term mortality and epilepsy in patients after brain abscess
T2 - A nationwide population-based matched cohort study
AU - Bodilsen, Jacob
AU - Dalager-Pedersen, Michael
AU - van de Beek, Diederik
AU - Brouwer, Matthijs C.
AU - Nielsen, Henrik
N1 - © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Background. We aimed to determine the long-term risks of mortality and new-onset epilepsy after brain abscess. Methods. Using nationwide population-based medical registries, we examined all patients with first-time brain abscess in Denmark, 1982–2016. Comparison cohorts individually matched on age, sex, and residence were identified, as were siblings of all study participants. Next, we computed cumulative incidences and hazard rate ratios (HRRs) with 95% confidence intervals of mortality and new-onset epilepsy among study populations. Results. We identified 1384 brain abscess patients (37% females) with a median follow-up time of 5.9 years (interquartile range [IQR] 1.1–14.2). The 1-year, 2–5 year, and 6–30 year mortality of patients after brain abscess was 21%, 16%, and 27% as compared to 1%, 6%, and 20% for population controls. Cox regression analyses adjusted for Charlson comorbidity index score showed 1-year, 2–5 year, and 6–30 year HRRs of 17.5 (13.9–22.0), 2.61 (2.16–3.16), and 1.94 (1.62–2.31). The mortality in brain abscess patients was significantly increased regardless of sex or age group except among subjects 80 years or older, and in both previously healthy individuals and immunocompromised persons. Among the 30-day survivors of brain abscess (median follow-up 7.6 years [IQR 2.2–15.5]), new-onset epilepsy occurred in 32% compared to 2% in matched population controls. Cause-specific Cox regression analysis adjusted for stroke, head trauma, alcohol abuse, and cancer showed 1-year, 2–5 year, and 6–30 year HRRs for new-onset epilepsy of 155 (78.8–304), 37.7 (23.0–59.9), and 8.93 (5.62–14.2). Conclusions. Brain abscess is associated with an increased long-term risk of mortality and new-onset epilepsy for several years after infection.
AB - Background. We aimed to determine the long-term risks of mortality and new-onset epilepsy after brain abscess. Methods. Using nationwide population-based medical registries, we examined all patients with first-time brain abscess in Denmark, 1982–2016. Comparison cohorts individually matched on age, sex, and residence were identified, as were siblings of all study participants. Next, we computed cumulative incidences and hazard rate ratios (HRRs) with 95% confidence intervals of mortality and new-onset epilepsy among study populations. Results. We identified 1384 brain abscess patients (37% females) with a median follow-up time of 5.9 years (interquartile range [IQR] 1.1–14.2). The 1-year, 2–5 year, and 6–30 year mortality of patients after brain abscess was 21%, 16%, and 27% as compared to 1%, 6%, and 20% for population controls. Cox regression analyses adjusted for Charlson comorbidity index score showed 1-year, 2–5 year, and 6–30 year HRRs of 17.5 (13.9–22.0), 2.61 (2.16–3.16), and 1.94 (1.62–2.31). The mortality in brain abscess patients was significantly increased regardless of sex or age group except among subjects 80 years or older, and in both previously healthy individuals and immunocompromised persons. Among the 30-day survivors of brain abscess (median follow-up 7.6 years [IQR 2.2–15.5]), new-onset epilepsy occurred in 32% compared to 2% in matched population controls. Cause-specific Cox regression analysis adjusted for stroke, head trauma, alcohol abuse, and cancer showed 1-year, 2–5 year, and 6–30 year HRRs for new-onset epilepsy of 155 (78.8–304), 37.7 (23.0–59.9), and 8.93 (5.62–14.2). Conclusions. Brain abscess is associated with an increased long-term risk of mortality and new-onset epilepsy for several years after infection.
KW - Brain abscess
KW - Cerebral abscess
KW - Epilepsy
KW - Matched cohort study
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85099326655&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/cid/ciz1153
DO - https://doi.org/10.1093/cid/ciz1153
M3 - Article
C2 - 31773138
SN - 1058-4838
VL - 71
SP - 2825
EP - 2832
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -