From the dermatology foundation
Serious infections in hospitalized patients with psoriasis in the United States

Presented in part at the Society for Investigative Dermatology 2016 Annual Meeting in Scottsdale, AZ on May 12, 2016.
https://doi.org/10.1016/j.jaad.2016.04.005Get rights and content

Background

Patients with psoriasis have multiple risk factors for serious infections, including immune dysregulation, systemic immunosuppressive medications, and comorbid health conditions.

Objective

We sought to determine rates and predictors of serious infections in hospitalized psoriasis patients and quantify costs of care, length of stay, and mortality.

Methods

We conducted a cross-sectional study of the Nationwide Inpatient Sample from 2002 to 2012, containing a representative 20% sample of all hospitalizations in the United States.

Results

In multivariate logistic regression models, psoriasis was associated with multiple serious infections, including methicillin-resistant Staphylococcus aureus (odds ratio [OR] 1.76, 95% confidence intervals [CI] 1.52-2.03), cellulitis (OR 3.21, 95% CI 3.12-3.30), herpes simplex virus infection (OR 2.21, 95% CI 1.70-2.89), infectious arthritis (OR 1.82, 95% CI 1.58-2.09), osteomyelitis (OR 1.31, 95% CI 1.18-1.46), meningitis (OR 1.31, 95% CI 1.16-1.47), encephalitis (OR 1.22, 95% CI 1.02-1.47), and tuberculosis (OR 1.34, 95% CI 1.20-1.49). Among patients with psoriasis, rates of serious infections increased over all time intervals analyzed (P = .01) and were significantly higher compared with those without psoriasis across all time intervals (P < .0001). The mean length of stay (6.6 ± 0.1 days) and cost of care ($13,291 ± $166) for psoriasis patients with serious infections was higher than that of psoriasis patients without serious infections (4.6 ± 0.03 days; $11,003 ± $96; P < .0001).

Limitations

The study was limited to inpatients. Medication data were not available.

Conclusion

Serious infections are increasing in incidence in US inpatients with psoriasis.

Section snippets

Methods

The 2002 to 2012 Nationwide Inpatient Sample (NIS) was analyzed. The NIS is sponsored by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ).10 Each year of NIS contains an approximately 20% stratified representative sample of all hospitalizations in the United States. Sample weights were created by NIS that factored the sampling design of hospitals. These sample weights were needed to provide representative estimates of hospital

Results

Overall, there were 87,039,711 discharges captured in the NIS between the years 2002 and 2012. There were 2738 primary admissions for psoriasis and 184,508 secondary diagnoses of psoriasis (weighted: 13,051 and 885,115, respectively). Patients with psoriasis (age 59.9 ± 0.2 years) were older than patients without psoriasis (age 47.9 ± 0.1 years), 47.5% female, and mostly white (Table I). Serious infections represented 28.2% of all hospitalizations in patients with psoriasis, but only 21.0% of

Discussion

This study demonstrated that serious infections were significantly higher in prevalence for inpatients with psoriasis than for inpatients without psoriasis. Psoriasis was associated with cellulitis, herpes simplex virus infection, fungal infections, infectious arthritis, viral infections, tuberculosis, osteomyelitis, meningitis, encephalitis, septicemia, enterocolitis, MRSA, MSSA, and C difficile infection even after adjusting for demographic factors. The infections associated with highest

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    This publication was made possible with support from the Agency for Healthcare Research and Quality, grant number K12HS023011, the Dermatology Foundation. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

    Conflicts of interest: None declared.

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