Department of Dermatology, University Hospitals Leuven, Leuven, Belgium.
Katholieke Universiteit Leuven, Leuven, Belgium.
Ann Med. 2021 Dec;53(1):1074-1081. doi: 10.1080/07853890.2021.1942974.
Psoriasis is a chronic inflammatory skin disease associated with numerous comorbidities. Psoriasis has been linked to an increased risk of metabolic syndrome and atherosclerotic arterial disease. Inflammatory conditions are known to increase the risk of venous thromboembolism (VTE), a frequent cause of morbidity and mortality. However, the relationship between psoriasis and VTE has received little attention and existing studies have shown conflicting results.
This systematic review aims to perform a meta-analysis on VTE in psoriasis patients.
We conducted a systematic electronic search of the incidence of VTE (pulmonary embolism [PE], deep venous thrombosis [DVT] and/or retinal vein occlusion [RVO]) in psoriasis patients on PubMed, Web of Science, Embase and Cochrane (specifics: see Appendix 1 in Supporting information). Only English literature and full manuscripts were included; abstracts were excluded. Pooled risk ratio and 95% confidence interval were calculated using Review Manager.
Seven articles were included. Each study separately indicated a correlation between psoriasis and VTE after adjustment for several clinical parameters. The confounders included in the adjustment differed between studies, but all included adjustment for age, gender and comorbidities. A meta-analysis of the unadjusted data of the five studies that reported raw data on number of VTE events and patient follow-up (person-years) showed a pooled risk ratio for VTE and psoriasis of 1.29 (95% CI: 0.92-1.81). The statistical heterogeneity was high with of 97%.
Published data adjusted for key confounders demonstrate in general a significantly increased prevalence of VTE in psoriasis patients. Both psoriasis severity and number of confounders assessed seem to have an impact on this correlation. In this review, we pooled unadjusted data of the studies and we found a non-significant increased risk for VTE in psoriasis patients compared to healthy controls. This discrepancy suggests that psoriasis severity, age, gender or comorbidities may influence the risk of VTE in subgroups of the psoriasis population. Future research to identify subgroups at risk for VTE is warranted.Key messagesThe included studies reported an increased risk of VTE, DVT, PE and RVO in psoriasis patients.A meta-analysis was performed on five studies that reported raw data and showed that the pooled risk ratio for VTE in psoriasis patients overall was increased, however not significantly, compared to healthy controls.Further research to pinpoint psoriasis subgroups at risk (e.g. severe psoriasis patients, younger age, associated comorbidities) of developing VTE is warranted.
银屑病是一种与多种合并症相关的慢性炎症性皮肤病。银屑病与代谢综合征和动脉粥样硬化性动脉疾病的风险增加有关。已知炎症状态会增加静脉血栓栓塞症（VTE）的风险，VTE 是发病率和死亡率的常见原因。然而，银屑病与 VTE 之间的关系尚未得到充分关注，现有研究结果存在矛盾。
本系统评价旨在对银屑病患者的 VTE 进行荟萃分析。
我们在 PubMed、Web of Science、Embase 和 Cochrane 上进行了系统性电子检索，以确定银屑病患者 VTE（肺栓塞[PE]、深静脉血栓形成[DVT]和/或视网膜静脉阻塞[RVO]）的发生率，检索词详见附录 1（支持信息）。仅纳入英文文献和全文文献；排除摘要。使用 Review Manager 计算汇总风险比和 95%置信区间。
纳入了 7 篇文章。在调整了几个临床参数后，每项研究都单独表明了银屑病与 VTE 之间存在相关性。调整中纳入的混杂因素因研究而异，但均包括年龄、性别和合并症的调整。对 5 项报告 VTE 事件和患者随访（人年）原始数据的研究的未调整数据进行荟萃分析显示，VTE 和银屑病的汇总风险比为 1.29（95%CI：0.92-1.81）。异质性很高，为 97%。
已发表的经关键混杂因素调整的数据总体表明，银屑病患者 VTE 的患病率显著增加。银屑病的严重程度和评估的混杂因素数量似乎都对这种相关性有影响。在本综述中，我们对研究的未调整数据进行了汇总，发现与健康对照组相比，银屑病患者的 VTE 风险略有增加，但无统计学意义。这种差异表明，在银屑病患者亚组中，银屑病严重程度、年龄、性别或合并症可能会影响 VTE 的风险。需要进一步研究以确定发生 VTE 的风险亚组（例如，严重银屑病患者、年龄较小、相关合并症）。
纳入的研究报告称，银屑病患者的 VTE、DVT、PE 和 RVO 风险增加。对报告原始数据的五项研究进行了荟萃分析，结果表明，银屑病患者总体 VTE 的汇总风险比有所增加，但与健康对照组相比无显著差异。需要进一步研究以确定易发生 VTE 的银屑病亚组（例如，严重银屑病患者、年龄较小、相关合并症）。
