Coulanges Edwine K, Wallace Resean M, Waller Jennifer L, Baer Stephanie L, Bollag Wendy B
Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
Department of Family and Community Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
Am J Med Sci. 2025 Jul;370(1):12-18. doi: 10.1016/j.amjms.2025.03.010. Epub 2025 Mar 15.
Porphyria cutanea tarda (PCT) is one of many conditions characterized by increased photosensitivity, manifesting as blistering lesions on sun-exposed skin. Due to the increased photosensitivity and skin fragility, PCT patients are more susceptible to infections. Individuals with end-stage renal disease (ESRD), a potential complication of PCT, also exhibit an increased risk of infection. Due to these combined risks, this retrospective cohort study sought to determine if PCT is an independent risk factor for certain infections in the ESRD population.
This study examined dialysis recipients within the United States Renal Data System database from 2005 to 2019. A diagnosis of PCT was determined using International Classification of Disease (ICD)-9 and ICD-10 codes and identified 1,019 (0.07 %) out of a total of 1,398,765 ESRD patients who met the inclusion and exclusion criteria. Bacterial infections, cellulitis, blisters, abscesses, and bacteremia were queried as outcomes. Logistic regression analysis determined the impact of PCT on the risk of each infection after controlling for demographic and clinical factors.
PCT was associated with a significantly decreased risk for 3 out of the 5 outcomes: bacterial infections (adjusted odds ratio: 0.50; 95 % confidence interval: 0.43-0.58), cellulitis (0.61; 0.53-0.71), and bacteremia (0.44; 0.38-0.52). No significant positive or negative association was found between PCT and blisters or abscesses.
These results indicate that ESRD patients with PCT are actually at decreased risk of some infections compared with ESRD patients without comorbid disease. The reason is unclear but could be related to either the disease process or its clinical management.
迟发性皮肤卟啉病（PCT）是众多以光敏性增加为特征的病症之一，表现为暴露于阳光下的皮肤出现水疱性病变。由于光敏性增加和皮肤脆弱，PCT患者更容易感染。终末期肾病（ESRD）是PCT的一种潜在并发症，这类患者也有更高的感染风险。鉴于这些综合风险，这项回顾性队列研究旨在确定PCT是否为ESRD人群中某些感染的独立危险因素。
本研究调查了2005年至2019年美国肾脏数据系统数据库中的透析患者。使用国际疾病分类（ICD）-9和ICD-10编码确定PCT诊断，在总共1398765名符合纳入和排除标准的ESRD患者中识别出1019例（0.07%）。将细菌感染、蜂窝织炎、水疱、脓肿和菌血症作为研究结果进行查询。在控制人口统计学和临床因素后，采用逻辑回归分析确定PCT对每种感染风险的影响。
PCT与5种结果中的3种风险显著降低相关：细菌感染（调整后的优势比：0.50；95%置信区间：0.43-0.58）、蜂窝织炎（0.61；0.53-0.71）和菌血症（0.44；0.38-0.52）。未发现PCT与水疱或脓肿之间存在显著的正相关或负相关。
这些结果表明，与无合并症的ESRD患者相比，患有PCT的ESRD患者某些感染的风险实际上降低了。原因尚不清楚，但可能与疾病过程或临床管理有关。
