Influenza infection is a cause of exacerbations in patients with chronic pulmonary diseases. The aim of this study was to investigate the clinical outcomes and identify risk factors associated with hospitalization and mortality following influenza infection in adult patients with bronchiectasis. Using the Chang Gung Research Database, we identified patients with bronchiectasis and influenza-related infection (ICD-9-CM 487 and anti-viral medicine) between 2008 and 2017. The main outcomes were influenza-related hospitalization and in-hospital mortality rate. Eight hundred sixty-five patients with bronchiectasis and influenza infection were identified. Five hundred thirty-six (62%) patients with bronchiectasis were hospitalized for influenza-related infection and 118 (22%) patients had respiratory failure. Compared to the group only seen in clinic, the hospitalization group was older, with more male patients, a lower FEV_1, higher bronchiectasis aetiology comorbidity index (BACI), and more acute exacerbations in the previous year. Co-infections were evident in 55.6% of hospitalized patients, mainly caused by Pseudomonas aeruginosa (15%), fungus (7%), and Klebsiella pneumoniae (6%). The respiratory failure group developed acute kidney injury (36% vs. 16%; p < 0.001), and shock (47% vs. 6%; p < 0.001) more often than influenza patients without respiratory failure. The overall mortality rate was 10.8% and the respiratory failure group exhibited significantly higher in-hospital mortality rates (27.1% vs. 6.2%; p < 0.001). Age, BACI, and previous exacerbations were independently associated with influenza-related hospitalization. Age, presence of shock, and low platelet counts were associated with increased hospital mortality. Influenza virus caused severe exacerbation in bronchiectasis, especially in those who were older and who had high BACI scores and previous exacerbations. A high risk of respiratory failure and mortality were observed in influenza-related hospitalization in bronchiectasis. We highlight the importance of preventing or treating influenza infection in bronchiectasis.

The comparison of clinical effectiveness and safety across different nonvitamin K antagonist direct oral anticoagulants (DOACs) in Asian patients with venous thromboembolism (VTE) remains unclear. Therefore, we assessed the real-world benefits of different DOACs in these patients. A cohort of 1480 patients with VTE were identified from the Chang Gung Research Database between 1 January 2012, and 31 December 2019. The composite outcomes of recurrent VTE and major bleeding were evaluated for four DOACs. The composite outcomes of recurrent VTE and major bleeding occurred in 9.06%, 9.80%, 8.61%, and 10.86% of the apixaban, dabigatran, edoxaban, and rivaroxaban groups, respectively, within 12 months of treatment initiation. The risk of the composite outcomes was similar in the rivaroxaban group and the apixaban, dabigatran, and edoxaban groups, with a subdistribution hazard ratio (SHR) of 0.80 (95% CI, 0.49–1.29), 0.81 (95% CI, 0.34–1.95), and 0.76 (95% CI, 0.42–1.39), respectively. No significant differences in the rates of recurrent VTE or major bleeding were observed between the rivaroxaban and other DOAC groups at the 12-month follow-up. According to real-world practice in Asian patients with VTE, the DOAC type was not associated with the differences in the risk of recurrent VTE or major bleeding within 12 months of treatment initiation.

Aim: Sepsis greatly increases morbidity and mortality in patients with systemic lupus erythematosus (SLE). Conventional treatments, particularly glucocorticoids (GCs), raise infection risk. This retrospective cohort study aims to investigate the association of Traditional Chinese Medicine (TCM) use with sepsis incidence, mortality, and GC dependence in patients with SLE, based on data from the Chang Gung Research Database (CGRD).Methods: Patients in Taiwan with newly diagnosed SLE were enrolled from the CGRD between 2005 and 2020. They were stratified into groups based on TCM treatment post‐diagnosis. Outcomes included sepsis incidence and the dose and duration of GC usage. Data were analyzed using Cox proportional hazard models and Kaplan–Meier analysis.Results: The study included 10 846 newly diagnosed patients with SLE, of whom 1801 received at least 28 days of TCM treatment, while 8302 did not. After propensity score matching, 5403 and 1801 individuals were included in the non‐TCM and TCM groups, respectively, with no significant baseline differences in age, sex, biochemical profiles, and comorbidities between the groups. Integrative TCM usage was associated with a significantly lower risk of sepsis (adjusted hazard ratio [aHR]: 0.49; 95% confidence interval [CI]: 0.40–0.60, p < 0.001) and mortality rate (aHR 0.52, 95% CI 0.44–0.60, p < 0.001) over an 18‐year period. Additionally, the TCM group had a significantly lower daily GC dose (1.74 vs. 2.47 units/day; p = 0.02).Conclusion: TCM use was significantly associated with lower risks of sepsis and lower GC dosage in patients with SLE, suggesting its potential as an integrative therapy.