The risk of organ-based comorbidities in psoriasis: a systematic review and meta-analysis

Tang, Xuemei; Chen, Ling

doi:10.1016/j.abd.2021.10.007

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ORIGINAL ARTICLE • An. Bras. Dermatol. 97 (5) • Sep-Oct 2022 • https://doi.org/10.1016/j.abd.2021.10.007 copy

The risk of organ-based comorbidities in psoriasis: a systematic review and meta-analysis^☆ ☆ Study conducted at the Southwest Medical University, Luzhou, Sichuan, China.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The close relationship between psoriasis and concomitant diseases is widely accepted. However, a comprehensive analysis of organ-based comorbidities in psoriasis is still lacking.

Objective:

The authors aimed to present the risk of organ-based comorbidities in psoriasis by comparing the general population.

Methods:

The authors retrieved a search of Pubmed, EMBASE, and Cochrane databases for studies reporting organ-based comorbidities in psoriasis versus the general population. Observational studies that met the following criteria were assessed: 1) Psoriasis diagnosis; 2) Cardiovascular or kidney or liver or respiratory or cerebrovascular outcomes; 3) Comparison group of individuals without psoriasis. Pooled Relative Risks (pRRs) and 95% Confidence Intervals (CIs) were calculated by using the random-effect model.

Results:

Fifteen observational studies with 216,348 psoriatic patients and 9,896,962 individuals from the general population were included. Psoriasis showed a greater risk of organ-based comorbidities. Compared to the general population, pRR for all organ-based comorbidities was 1.20 (95% CI 1.11–1.31) in psoriasis, and pRR was lower in mild 0.61 (95% CI 0.46–0.81) than in moderate/severe patients. pRR was 1.20 (95% CI 1.11–1.30) for cardiovascular, 1.56 (95% CI 1.20–2.04), and 1.75 (95% CI 1.33–2.29) for cerebrovascular and liver diseases, respectively. pRR for coexisting renal and cardiovascular events was 1.09 (95% CI 1.01–1.18). pRR for coexisting renal and cerebrovascular events was 1.28 (95% CI 0.99–1.66). pRR for coexisting renal and liver diseases was 1.46 (95% CI 1.10–1.94). pRR for coexisting cardiovascular and liver diseases was 1.41 (95% CI 1.11–1.80).

Study limitations:

There is heterogeneity.

Conclusion:

Psoriasis has a higher risk of single and multiple organ-based comorbidities than the general population. The present study will further improve attention to psoriasis as a systemic inflammatory disease.

KEYWORDS
Comorbidity; Meta-analysis; Psoriasis; Risk; Systematic review

Study	Region	Study period	Data sources	Mean age, (y); Female (%)		Nº of psoriatic patients		Nº of Control		Specific comorbidities	NOS
Study	Region	Study period	Data sources	Psoriasis	Control	All	Comorbidities	All	Comorbidities	Specific comorbidities	NOS
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Ahlehoff O, 2012³¹31 Ahlehoff O, Gislason GH, Jørgensen CH, Lindhardsen J, Charlot M, Olesen JB, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study. Eur Heart J. 2012;33:2054–64.	Danish	1997.01 – 2006.12	The Danish National Patient Register	46.1 ± 16.9; 49.72	43.7 ± 19.7; 49.03	39558	530	4478926	55660	CVD, KD, CD, PD	7
Armstrong AW, 2013³²32 Armstrong AW, Azizi S, Wu J, Harskamp CT, Farrow J, Johnson MAN, et al. Psoriasis, electrocardiographic characteristics, and incidence of atrial fibrillation. Arch Dermatol Res. 2013;305:891–7.	US	2004 – 2009	University of California Davis	53 (40–63); 59.19	53 (40–63); 51.11	2078	1776	6234	3616	CVD, CD, PD	6
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Schell C, 2015³⁸38 Schell C, Schleich R, Walker F, Yazdi AS, Lerche H, Röcken M, et al. Restless legs syndrome in psoriasis: an unexpected comorbidity. Eur J Dermatol. 2015;25:255–60.	German	NR	Eberhard Karls University Tübingen	48.3 ± 15.6; 43.33	49.1 ± 18.6; 60.00	300	158	300	150	CVD, KD, PD, LD	6
Tollefson MM, 2018²⁸28 Tollefson MM, Houten HK, Asante D, Yao X, Kremers HM. Association of Psoriasis With Comorbidity Development in Children With Psoriasis. JAMA Dermatol. 2018;154:286–92.	US	2004.01 – 2013.12	Optum Laboratories Data Warehouse	12.0 (4.4); 53.52	12.0 (4.4); 53.52	29957	1200	29957	646	CVD, LD	8
Vena GA, 2010³⁹39 Vena GA, Altomare G, Ayala F Berardesca E, Calzavara-Pinton P, Chimenti S, et al. Incidence of psoriasis and association with comorbidities in Italy: a 5-year observational study from a national primary care database. Eur J Dermatol. 2010;20:593–8.	Italy	2001 – 2005	The Health Search/Thales Database	52.5 (16.5); 47.41	52.4 (16.4); 52.59	3516	399	17580	1425	CVD, PD	6
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Yeung H, 2013⁴⁰40 Yeung H, Takeshita J, Mehta NN, Kimmel SE, Ogdie A, Margolis DJ, et al. Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. JAMA Dermatol. 2013;149:1173–9.	UK	NR	The Health Improvement Network	46 (37–55); 49.43	46 (36–55); 52.91	9035	1945	90350	17502	CVD, KD, CD, PD, LD	6

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The risk of organ-based comorbidities in psoriasis: a systematic review and meta-analysis☆ ☆ Study conducted at the Southwest Medical University, Luzhou, Sichuan, China.

Abstract

Background:

Objective:

Methods:

Results:

Study limitations:

Conclusion:

The risk of organ-based comorbidities in psoriasis: a systematic review and meta-analysis^☆ ☆ Study conducted at the Southwest Medical University, Luzhou, Sichuan, China.