178 Serious infections are on the rise in US patients with psoriasis

Abstract

Psoriasis is a chronic inflammatory skin disorder with immune dysregulation and use of systemic immunosuppressive treatments that may predispose toward serious infections. We sought to determine the rates of serious infections in children and adults with psoriasis. We analyzed data from the 2002-2012 Nationwide Inpatient Sample, containing a 20% sample of all US hospitalizations. Psoriasis was determined by a validated algorithm and 15 serious infections were assessed using ICD-9-CM codes. Psoriasis was associated with significantly higher odds of pneumonia (logistic regression, odds ratio [95% confidence interval]: 1.13 [1.11-1.15]), septicemia (1.23 [1.21-1.26]), cellulitis (3.90 [3.82-3.98]), necrotizing fasciitis (1.64 [1.20-2.25]), diverticulitis (1.41 [1.34-1.48]), enterocolitis (1.15 [1.11-1.20]), osteomyelitis (1.63 [1.48-1.80]), infectious arthritis (2.32 [2.07-2.60]), encephalitis (1.30 [1.11-1.51]), any viral (1.21 [1.16-1.26]) or herpes simplex viral (1.55 [1.21-1.99]) infection and fungal infection (2.39 [2.34-2.45]), not associated with meningitis (1.05 [0.94-1.16]) and associated with lower odds of pyelonephritis (0.86 [0.79-0.94]) and appendicitis (0.50 [0.47-0.54]). Infection rates significantly increased in psoriasis patients from 2002 to 2012 for septicemia, pneumonia, diverticulitis, enterocolitis, encephalitis, any viral or fungal infection (analysis of variance with Tukey correction, P<0.05 for all). Serious infections increased at a faster rate (delta) in psoriasis compared with non-psoriasis patients for septicemia, pneumonia, necrotizing fasciitis, diverticulitis, pyelonephritis, enterocolitis, osteomyelitis, infectious arthritis, meningitis, encephalitis, fungal and herpes simplex virus infection in at least one time interval from 2002-2012. Multiple risk factors for these infections were identified, including age, race, sex, income, insurance status, hospital location, season of admission and number of chronic conditions (P<0.0001 for all). Future research is needed to determine how to reduce the risk of serious infections in patients with psoriasis.