AUTHOR=Chen Chia-Lun , Chang Fang-Cherng , Hung Yao-Min , Chou Mei-Chia , Yip Hei-Tung , Chang Renin , Wei James Cheng-Chung 

TITLE=Candida Infection as an Early Sign of Subsequent Sjögren's Syndrome: A Population-Based Matched Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.796324

DOI=10.3389/fmed.2021.796324

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p><italic>Candida</italic> infection is prevalent in patients with Sjögren's syndrome (SjS), which usually takes years to reach diagnosis. Is the link a two-way street? The role of <italic>Candida</italic> infection before SjS has not been examined clearly. This study was conducted to provide epidemiological evidence regarding the relationship between the first acquisition of <italic>Candida</italic> infection and subsequent SjS.</p></sec><sec><title>Methods</title><p>Totally, 23,494 individuals newly diagnosed with <italic>Candida</italic> infection were enrolled from 2000, to 2012. Controls (<italic>N</italic> = 93,976) were selected at a 1:4 ratio through propensity score matched (PSM) using the greedy algorithm. Exposure was defined according to the <italic>International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)</italic> codes.</p></sec><sec><title>Main Outcomes and Measures</title><p>SjS was recorded in the Registry for Catastrophic Illness Patients Database (RCIPD). Cox proportional hazard model was used to analyze the association and sensitivity analyses for cross-validation.</p></sec><sec><title>Results</title><p>Of 117,470 individuals (106,077 [89%] women), 23,494 individuals (20.0%) had <italic>Candida</italic> infection and 104 individuals (0.1%) developed SjS. The incidence of SjS was higher in the exposed group compared with the controls (1.92 vs. 0. 98 per 10,000 person-years) with adjusted hazard ratio (aHR) 1.90 (95% CI, 1.25–2.87). The aHRs in subgroups of aged 18–30 years, oral candidiasis and depression were 4.30 (95% CI, 1.60–11.55), 4.70 (4.70–13.93) and 6.34 (2.16–18.66). Sensitivity analyses yield consistent results.</p></sec><sec><title>Conclusions</title><p>Residents in Taiwan with <italic>Candida</italic> infection have higher risk of SjS. For early diagnosis of SjS, clinicians are advised to take <italic>Candida</italic> infection into account in some situation.</p></sec>