Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
Br J Dermatol. 2019 Jan;180(1):100-107. doi: 10.1111/bjd.16919. Epub 2018 Sep 26.
There are limited data regarding causes of mortality in patients with psoriasis or psoriatic arthritis (PsA).
This retrospective cohort study evaluated the risk and leading causes of mortality in patients with psoriasis or PsA.
Individuals with a hospital-based diagnosis of PsA or psoriasis were identified using the Danish National Patient Registry. Matched control individuals were identified from the general population. The main outcome measures were risk of death and cause-specific mortality in patients with psoriasis or PsA.
Death rates per 1000 patient-years (with 95% confidence intervals) vs. controls were 22·3 (19·7-24·9) vs. 13·9 (11·8-16·0) for patients with psoriasis and 10·8 (8·9-12·8) vs. 11·6 (9·6-13·6) for patients with PsA. Survival, according to stratified hazard ratios (HRs), was significantly lower in patients with psoriasis than in controls (HR 1·74, P < 0·001), but not in patients with PsA (HR 1·06, P = 0·19). Significantly increased risk of death was observed in patients with psoriasis vs. controls due to a number of causes; the highest risks were observed for diseases of the digestive system; endocrine, nutritional and metabolic diseases; and certain infectious and parasitic diseases (HRs 3·61, 3·02 and 2·71, respectively). In patients with PsA, increased mortality was observed only for certain infectious and parasitic diseases (HR 2·80) and diseases of the respiratory system (HR 1·46). Patients with psoriasis died at a younger age than controls (mean age 71·0 vs. 74·5 years, P < 0·001).
Patients with severe psoriasis have increased mortality risk compared with matched controls, due to a number of causes. Evidence to support an increased risk for patients with PsA was less convincing.
关于银屑病或银屑病关节炎（PsA）患者的死亡原因，数据有限。
本回顾性队列研究评估了银屑病或 PsA 患者的死亡风险和主要死亡原因。
使用丹麦全国患者登记处确定了患有 PsA 或银屑病的住院患者。从一般人群中确定了匹配的对照个体。主要结局指标是银屑病或 PsA 患者的死亡风险和特定原因死亡率。
银屑病患者的死亡率为每 1000 患者年 22.3（95%置信区间为 19.7-24.9），对照患者的死亡率为 13.9（11.8-16.0）；PsA 患者的死亡率为每 1000 患者年 10.8（8.9-12.8），对照患者的死亡率为 11.6（9.6-13.6）。根据分层危害比（HRs），银屑病患者的生存明显低于对照患者（HR 1.74，P<0.001），但 PsA 患者的生存没有差异（HR 1.06，P=0.19）。与对照患者相比，银屑病患者的死亡风险显著增加，原因有多种；其中，消化系统疾病、内分泌、营养和代谢疾病以及某些传染病和寄生虫病的风险最高（HRs 分别为 3.61、3.02 和 2.71）。在 PsA 患者中，仅观察到某些传染病和寄生虫病（HR 2.80）和呼吸系统疾病（HR 1.46）的死亡率增加。与对照患者相比，银屑病患者死亡年龄更小（平均年龄 71.0 岁 vs. 74.5 岁，P<0.001）。
与匹配的对照患者相比，严重银屑病患者的死亡风险增加，原因有多种。支持 PsA 患者风险增加的证据不太令人信服。
