J Cerebrovasc Endovasc Neurosurg.  2023 Jun;25(2):143-149. 10.7461/jcen.2023.E2022.09.001.

Association between ischemic stroke and pyogenic spondylitis in Korea: Nationwide longitudinal cohort study

• Lee SH
• Kim H
• Han Ib
• Sheen SH
• Hong JB
• Sohn S

• KMID: 2543510
• DOI: http://doi.org/10.7461/jcen.2023.E2022.09.001

Abstract

Objective
The purpose of this nationwide age- and sex- matched longitudinal study was to determine the pyogenic spondylitis (PS) increases the incidence of ischemic stroke (IS) in Korea.
Methods
From the National Health Insurance Service (NHIS), we collected the patient data for the period from January 1, 2004 to December 31, 2015. PS was classified according to the International Classification of Disease codes M46.2-M46.8, M49.2, and M49.3. By using a 1:5 age- and sex- stratified matching, a total of 628 patients and 3140 control subjects were included in the study. The IS incidence rates in PS and control group was calculated by using the Kaplan-Meier method. The outcome of hazard ratio of IS was estimated by Cox proportional hazards regression analyses. This study did not exclude PS as a result of postoperative complications.
Results
According to the study, 51 patients (8.12%) in the PS group and 201 patients (6.4%) in the control group experienced IS. The adjusted hazard ratio of IS in the PS group was 3.419 (95% CI: 2.473-4.729) after adjusting individual medical condition and demographics. Following the results of subgroup analysis, the risk ratio of IS was greater in most of the subgroup categories (male, female, age <65, age >65, non-diabetic, hypertensive, non-hypertensive, dyslipidemic and non-dyslipidemic subgroup). However, the risk of IS did not differ significantly in diabetic subgroup (95% CI: 0.953-4.360).
Conclusions
The risk rate of IS increased in patient with pyogenic spondylitis.

Keyword

Pyogenic spondylitis; Ischemic stroke; Epidemiology; Population

Figure

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  Fig. 1. Flow of cohort formation process. This study was a 12-year longitudinal cohort study completed on the basis of the NHIS-HEALS cohort. NHISS, National Health Insurance Service-Health Screening; NHIS, National Health Insurance Service

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  Fig. 2. The Kaplan-Meier curves with cumulative incidence of ischemic stroke in the pyogenic spondylitis and control groups.

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