Serious infections in hospitalized patients with psoriasis in the United States.
BACKGROUND
Patients with psoriasis have multiple risk factors for serious infections, including immune dysregulation, systemic immunosuppressive medications, and comorbid health conditions.


OBJECTIVE
We sought to determine rates and predictors of serious infections in hospitalized psoriasis patients and quantify costs of care, length of stay, and mortality.


METHODS
We conducted a cross-sectional study of the Nationwide Inpatient Sample from 2002 to 2012, containing a representative 20% sample of all hospitalizations in the United States.


RESULTS
In multivariate logistic regression models, psoriasis was associated with multiple serious infections, including methicillin-resistant Staphylococcus aureus (odds ratio [OR] 1.76, 95% confidence intervals [CI] 1.52-2.03), cellulitis (OR 3.21, 95% CI 3.12-3.30), herpes simplex virus infection (OR 2.21, 95% CI 1.70-2.89), infectious arthritis (OR 1.82, 95% CI 1.58-2.09), osteomyelitis (OR 1.31, 95% CI 1.18-1.46), meningitis (OR 1.31, 95% CI 1.16-1.47), encephalitis (OR 1.22, 95% CI 1.02-1.47), and tuberculosis (OR 1.34, 95% CI 1.20-1.49). Among patients with psoriasis, rates of serious infections increased over all time intervals analyzed (P = .01) and were significantly higher compared with those without psoriasis across all time intervals (P < .0001). The mean length of stay (6.6 ± 0.1 days) and cost of care ($13,291 ± $166) for psoriasis patients with serious infections was higher than that of psoriasis patients without serious infections (4.6 ± 0.03 days; $11,003 ± $96; P < .0001).


CONCLUSIONS
The study was limited to inpatients. Medication data were not available.


CONCLUSIONS
Serious infections are increasing in incidence in US inpatients with psoriasis.
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Derek Y
DY
Hsu
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Kenneth
K
Gordon
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: JonathanISilverberg@gmail.com.
Jonathan I
JI
Silverberg
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000191:economics* / Q000453:epidemiology*; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011565:Psoriasis / Q000150:complications* / Q000453:epidemiology; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult
biologics; cost of care; hospitalization; length of stay; methotrexate; psoriasis; serious infection