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Psoriasis Linked with Increased All-Cause Mortality

J Am Acad Dermatol; ePub 2018 Dec 24; Dhana, et al

Psoriasis is associated with increased mortality from all-causes in a dose-response manner with disease severity and from several specific causes, according to a recent study. Researchers included studies reporting all-cause or cause-specific mortality risk estimates in psoriasis patients compared with general population or subjects free of psoriasis. They calculated pooled relative risks (RRs) and 95% confidence intervals (CIs); 12 studies were included. They found:

  • The pooled RRs for all-cause mortality were 1.21 (95% CI 1.14-1.28) in psoriasis, 1.13 (95% CI 1.09-1.16) in mild psoriasis, and 1.52 (95% CI 1.35-1.72) in severe psoriasis.
  • The pooled RRs for cardiovascular mortality were 1.15 (95% CI 1.09-1.21) in psoriasis, 1.05 (95% CI 0.92-1.20) in mild psoriasis, and 1.38 (95% CI 1.09-1.74) in severe psoriasis.
  • For non-cardiovascular causes, mortality risk from liver disease, kidney disease, and infection was significantly increased in psoriasis, regardless of disease severity.
  • The mortality risk from liver and kidney disease was the highest.
  • There was also significantly increased mortality risk from neoplasms in severe psoriasis patients and from chronic lower respiratory disease in all and mild psoriasis patients.
Citation:

Dhana A, Yen H, Yen H, Cho E. All-cause and cause-specific mortality in psoriasis: A systematic review and meta-analysis. [Published online ahead of print December 24, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.12.037.

Commentary:

Psoriasis has been linked to several comorbidities, including cardiovascular disease, malignancies, and organ damage. This is the first report correlating these comorbidities with all-cause and cause-specific mortality risks. These findings suggest that psoriasis patients, particularly those with risk factors and severe disease, should receive appropriate screening and preventative interventions. The strength of this report is based on a large sample size and several sensitivity analyses.—Paul S. Yamauchi, MD, PhD; Clinical Assistant Professor of Dermatology David Geffen School of Medicine at UCLA; Harbor-UCLA Medical Center Division of Dermatology; Adjunct Associate Professor John Wayne Cancer Institute.

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