比较化脓性汗腺炎患者的总体合并症负担。
Comparative Overall Comorbidity Burden Among Patients With Hidradenitis Suppurativa.
机构信息
Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
出版信息
JAMA Dermatol. 2019 Jul 1;155(7):797-802. doi: 10.1001/jamadermatol.2019.0164.
IMPORTANCE
The overall comorbidity burden among patients with hidradenitis suppurativa (HS) has not been systematically evaluated.
OBJECTIVES
To investigate the standardized overall comorbidity burden among patients with HS and to compare it with the comorbidity burden in patients with psoriasis and a control group.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis was conducted of 5306 patients with HS, 14 037 patients with psoriasis, and 1 733 810 controls identified using electronic health records data from October 1, 2013, through October 1, 2018.
MAIN OUTCOME AND MEASURE
The primary outcome was the mean Charlson Comorbidity Index (CCI) score.
RESULTS
Each matched cohort had 3818 patients (2789 women and 1029 men; mean [SD] age, 45.7 [15.0]). Before matching, the overall mean (SD) CCI score was highest among the psoriasis cohort (2.33 [3.13]), followed by the HS cohort (1.80 [2.79]) and control cohort (1.26 [2.35]). In matched analyses, the overall mean (SD) CCI score was highest among the HS cohort (1.95 [2.96]), followed by the psoriasis cohort (1.47 [2.43]; P < .001) and control cohort (0.95 [1.99]; P < .001) patients. A total of 516 patients with HS (13.5%) had an overall mean CCI score of 5 or greater. Mean CCI score was highest for patients with HS across all sex, race, and age groups. The most common comorbidities among patients with HS were chronic pulmonary disease (1540 [40.3%]), diabetes with chronic complications (365 [9.6%]), diabetes without chronic complications (927 [24.3%]), and mild liver disease (455 [11.9%]). Patients with HS with a CCI score of 5 or greater had 4.97 (95% CI, 1.49-16.63) times the adjusted risk of 5-year mortality compared with patients with HS with a CCI score of zero.
CONCLUSIONS AND RELEVANCE
Patients with HS have a higher overall comorbidity burden compared with patients with psoriasis and a control group. A significant proportion of patients with HS have CCI scores of 5 or greater, which are associated with increased mortality. This degree of comorbidity burden may warrant multidisciplinary implementation of routine screening measures.
背景
目前尚未系统评估患有化脓性汗腺炎（HS）患者的总体合并症负担。
目的
调查 HS 患者的标准化总体合并症负担，并将其与银屑病患者和对照组的合并症负担进行比较。
设计、设置和参与者：这是一项使用电子健康记录数据进行的横断面分析，共纳入了 2013 年 10 月 1 日至 2018 年 10 月 1 日期间确诊的 5306 例 HS 患者、14037 例银屑病患者和 1733810 例对照者。
主要结局和测量指标
主要结局是Charlson 合并症指数（CCI）的平均值。
结果
每组匹配队列均有 3818 例患者（2789 例女性和 1029 例男性；平均[标准差]年龄，45.7[15.0]岁）。在匹配前，银屑病队列的总体平均（SD）CCI 评分最高（2.33[3.13]），其次是 HS 队列（1.80[2.79]）和对照组（1.26[2.35]）。在匹配分析中，HS 队列的总体平均（SD）CCI 评分最高（1.95[2.96]），其次是银屑病队列（1.47[2.43]；P<.001）和对照组（0.95[1.99]；P<.001）。共有 516 例 HS 患者（13.5%）的总体平均 CCI 评分≥5。所有性别、种族和年龄组的 HS 患者的 CCI 评分均最高。HS 患者最常见的合并症为慢性肺部疾病（1540 例[40.3%]）、伴有慢性并发症的糖尿病（365 例[9.6%]）、无慢性并发症的糖尿病（927 例[24.3%]）和轻度肝脏疾病（455 例[11.9%]）。CCI 评分≥5 的 HS 患者发生 5 年死亡的风险是 CCI 评分为 0 的 HS 患者的 4.97 倍（95%CI，1.49-16.63）。
结论和相关性
与银屑病患者和对照组相比，HS 患者的总体合并症负担更高。相当比例的 HS 患者的 CCI 评分为 5 或更高，与死亡率增加相关。这种合并症负担程度可能需要多学科实施常规筛查措施。
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