Comorbidities and inpatient mortality for Pemphigus in the United States.

Hsu, DY. Brieva, J. Sinha, AA. Langan, S. Silverberg, JI.
Br J Dermatol, 2016;174(6):1290-8.

The morbidity and mortality from pemphigus and its treatments have not been fully described. Previous studies found conflicting results about certain comorbidities and were limited by small sample sizes.

We examined a cross-sectional cohort of 87,039,711 hospitalized patients in the US to determine the inpatient comorbidities and mortality of pemphigus.

In multivariate survey logistic regression models adjusting for age, gender and race/ethnicity, pemphigus and its treatments were associated with 39 of 122 comorbidities examined. The disorders most strongly associated with pemphigus were Cushing’s syndrome (adjusted odds ratio [95% confidence interval]: 17.23 [2.41-122.90]), adrenal insufficiency (4.08 [1.71-9.73]), myasthenia gravis (6.92 [2.55-18.79]), mucositis (17.19 [7.73-38.22]), herpes infection (7.98 [3.62-17.62]), fungal infections (4.03 [3.60-4.52]), insomnia (18.02 [2.46-131.88]) and hidradenitis (5.34 [1.33-21.43]). Amongst malignancies, only leukemia (1.56 [1.08-2.24]) and non-Hodgkin’s lymphoma (1.52 [1.15-2.03]) were positively associated with pemphigus, but not any solid organ malignancies. Patients with a secondary diagnosis of pemphigus had higher mortality rates (3.20% [2.71-3.69%]) than those with a primary (1.60% [1.29-1.91%]) or no (1.78% [1.78-1.78%]) diagnosis of pemphigus (P<0.0001).

Pemphigus is associated with increased mortality likely through its association with numerous comorbid health conditions. Patients with pemphigus require improved access to dermatologic care and increased screening for the myriad comorbidities. This article is protected by copyright. All rights reserved.