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. 2021 Aug;41(8):2887-2895.
doi: 10.1007/s10792-021-01849-3. Epub 2021 Apr 16.

Mortality risk associated with endophthalmitis in West Virginia

Jeffrey Desilets  1 , Chang Sup Lee  2 , Wei Fang  3 , David M Hinkle  4   5
Affiliations

Mortality risk associated with endophthalmitis in West Virginia

Jeffrey Desilets et al. Int Ophthalmol. 2021 Aug.

Abstract

Purpose: To explore how endophthalmitis presented from 2009 to 2019 in a West Virginia population particularly affected by the national opioid crisis. The analysis explores the relationship between the type of endophthalmitis and mortality, accounting for factors including age, gender, type of organism, and intravenous drug use (IVDU).

Methods: The electronic health record of West Virginia University (WVU) Medicine was queried for all patients managed for endophthalmitis from October 2009 to October 2019. For each of the included subjects, age, gender, history of IVDU, culture results, concomitant endocarditis, type of endophthalmitis, and the date of diagnosis were extracted. Mortality data were obtained from WVU's electronic medical record, the Social Security Death Index, and public obituaries. Mortality results were represented by a Kaplan-Meier Survival curve following each patient for one year from the date of diagnosis. Results were analyzed using unadjusted and adjusted Cox Proportional Hazard models.

Results: One-year mortality was 14 out of 113 endogenous cases (12.4%) compared to 6 out of 173 exogenous cases (3.5%). Endogenous endophthalmitis cases had significantly higher mortality than exogenous ones within one year of diagnosis (p = 0.0034). The unadjusted Cox proportional hazards model revealed that the type of endophthalmitis (endogenous vs. exogenous) was the only variable with a significant impact on 1-year mortality with a hazard ratio of 3.78 (p = 0.01). However, the hazard ratio for endogenous infections rose to 10.91 (CI 3.544-33.595) when the other variables of age, gender, organism, and IVDU were controlled (p < 0.01). The Cox proportional hazard ratios for age group, gender, organism type, and history of IVDU were not significantly different when adjusted for all other variables.

Conclusion: Endogenous cases, which were significantly overrepresented in West Virginia, were associated with a significantly higher 1-year mortality rate than the exogenous ones. Age, gender, organism type, and history of IVDU have less, if any, modifying effect on mortality.

Keywords: Drug use-related endophthalmitis; Endogenous endophthalmitis; Exogenous endophthalmitis.

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Conflict of interest statement

Conflicts of interest The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Kaplan–Meier plot of 1-year mortality associated with endophthalmitis. The 1-year mortality was significantly higher in the endogenous group (12.2%) than the exogenous group (3.2%) (p = 0.0040)
Fig. 2
Fig. 2
Unadjusted Cox Proportional Hazards Model. Hazard ratios reflect the risk of mortality without standardization for the other variables in the model. The only variable with a significant impact on mortality was the type of endophthalmitis (endogenous vs. exogenous) with a hazard ratio of 4.1 (p = 0.01)
Fig. 3
Fig. 3
Multiple Cox Proportional Hazards Model. Hazard ratios reflect the risk of mortality with standardization for the other variables in the model. Endogenous endophthalmitis is a more significant risk factor, with a hazard ratio of 11.44, when all other variables are controlled (p < 0.01)
Fig. 4
Fig. 4
Multiple Cox Proportional Hazards Model. Hazard ratios reflect the risk of mortality with standardizaron for the other variables in the model. The type of endophthalmitis (endogenous vs. exogenous) becomes a more significant risk factor, with a hazard ratio of 10.91, when all other variables are controlled (p < 0.01)
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