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Published on: March 1, 2024
Increased Incidence of Critical Illness in Psoriasis
Ruth Ann Marrie1,2, Charles N Bernstein1,3, Christine A Peschken1,2
11 Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
Insights
Individuals with psoriasis face a higher risk of intensive care unit (ICU) admission and increased mortality after ICU stays. This study highlights the significant health care utilization burden associated with psoriasis.
Area of Science:
- Dermatology and Public Health
- Epidemiology of Chronic Diseases
Background:
- Psoriasis is linked to increased comorbidity and morbidity.
- Understanding health care utilization, particularly intensive care unit (ICU) admission risk, in psoriasis patients is limited.
Purpose of the Study:
- To compare ICU admission incidence and post-ICU mortality rates in psoriasis patients versus a matched general population.
- To quantify the excess risk of critical care admission and outcomes for individuals with psoriasis.
Main Methods:
- Population-based administrative data from Manitoba, Canada, were used.
- A cohort of 40,930 prevalent psoriasis cases was matched with 150,210 individuals without psoriasis.
- Cox regression models adjusted for demographic and clinical factors were employed to compare ICU admission and mortality.
Main Results:
- The 10-year cumulative incidence of ICU admission was 21% higher in psoriasis patients (5.6%) compared to the matched cohort (incidence rate ratio: 1.21).
- Crude in-hospital mortality for ICU admissions was 32% higher in the psoriasis cohort (11.5%) versus the non-psoriasis cohort (8.7%).
- Elevated mortality rates post-ICU admission persisted in psoriasis patients across all time points.
Conclusions:
- Psoriasis is independently associated with a significantly increased risk of ICU admission.
- Patients with psoriasis experience a higher risk of mortality following ICU admission.
Background:
Psoriasis is associated with an increased risk of comorbid disease. Despite the recognition of increased morbidity in psoriasis, the effects on health care utilisation remain incompletely understood. Little is known about the risk of intensive care unit (ICU) admission in persons with psoriasis.
Objective:
To compare the incidence of ICU admission and post-ICU mortality rates in a psoriasis population compared with a matched population without psoriasis.
Methods:
Using population-based administrative data from Manitoba, Canada, we identified 40 930 prevalent cases of psoriasis and an age-, sex-, and geographically matched cohort from the general population (n = 150 210). We compared the incidence of ICU admission between populations using incidence rates and Cox regression models adjusted for age, sex, socioeconomic status, and comorbidity and compared mortality after ICU admission.
Results:
Among incident psoriasis cases (n = 30 150), the cumulative 10-year incidence of ICU admission was 5.6% (95% confidence interval [CI], 5.3%-5.8%), 21% higher than in the matched cohort (incidence rate ratio, 1.21; 95% CI, 1.15-1.27). In the prevalent psoriasis cohort, crude mortality in the ICU was 11.5% (95% CI, 9.9%-13.0%), 32% higher than observed in the matched population admitted to the ICU (8.7%; 95% CI, 8.3%-9.1%). Mortality rates after ICU admission remained elevated at all time points in the psoriasis cohort compared with the matched cohort.
Conclusion:
Psoriasis is associated with an increased risk for ICU admission and with an increased risk of mortality post-ICU admission.
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