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Infectious complications in bullous pemphigoid: an analysis of risk factors
Yee Wei Phoon1, Stephanie M C Fook-Chong2, Hong Yi Koh1
1Department of Dermatology, Singapore General Hospital, Singapore.
Background:
Infections are common in bullous pemphigoid and contribute to significant mortality.
Objectives:
We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort.
Design:
A retrospective cohort study conducted at an academic medical center.
Results:
In all, 97 patients were included. Infectious complications occurred in 54 patients (56%) and the median duration from diagnosis to first episode of infection was 3 months. Bacteremia occurred in 14 patients (26%) and 26 of 30 deaths (87%) were attributable to infections. On univariate analysis, significant risk factors include low Karnofsky score (<60) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-8.3; P < .01), high Charlson comorbidity index score (≥6) (OR 2.4, 95% CI 1.1-5.5; P = .04), and dementia (OR 4.9, 95% CI 1.5-15.8; P = .01). On multivariate analysis, low Karnofsky score and dementia remained significant with an OR of 3.3 (95% CI 1.1-10.0; P = .03) and OR of 4.2 (95% CI 1.2-14.7; P = .03), respectively.
Limitations:
Limitations include potential selection bias as a result of study design and primary outcome measures focused on significant infections requiring hospitalizations. Minor infections were not included.
Conclusions:
Identified risk factors for infectious complications include functional impairment and the presence of dementia, which may allow for better risk stratification and individualized treatment of bullous pemphigoid.
Insights
Infections are a major concern in bullous pemphigoid, leading to high mortality. Functional impairment and dementia are key risk factors for these complications.
Area of Science:
- Dermatology
- Infectious Diseases
- Epidemiology
Background:
- Infections are a frequent and serious complication in bullous pemphigoid (BP).
- These infections significantly contribute to mortality rates in BP patients.
Purpose of the Study:
- To comprehensively define the range of infectious complications in bullous pemphigoid.
- To identify specific risk factors associated with these infections within a BP cohort.
Main Methods:
- A retrospective cohort study was conducted.
- Data were collected from patients treated at an academic medical center.
Main Results:
- Infectious complications were observed in 56% of the 97 included patients.
- Bacteremia occurred in 26% of patients, and infections caused 87% of deaths.
- Low Karnofsky score and dementia were identified as significant independent risk factors for infection.
Conclusions:
- Functional impairment and dementia are critical risk factors for infectious complications in bullous pemphigoid.
- These findings can aid in better risk stratification and personalized treatment strategies for BP patients.
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