Patients with psoriasis may not live as long

A new systematic review and meta-analysis suggest that patients suffering from psoriasis may not live as long. This is the first study reviewing all-cause mortality and cause-specific mortality in patients with psoriasis.

Psoriasis is known to be associated with multiple comorbid conditions including metabolic syndrome, cardiovascular disease, infections, and malignancies. The pathophysiologic link between psoriasis and its associated comorbid conditions has not yet been elucidated. However, several studies have demonstrated increased mortality in patients suffering from psoriasis which may be related to the burden of the associated comorbidities.

The researchers led by Dr. Asher Dhana at The University of Cape Town performed a systematic review and meta-analysis to clarify mortality risk. Ultimately twelve international studies published between 1999 and 2017 were included in the systematic review and meta-analysis. The researchers analyzed the data from these studies and pooled the results to report all cause mortality, and cause-specific mortality. The researchers further divided the patients analyzed in the studies by severity of their psoriasis.

The results demonstrated that all-cause mortality was increased in a patient with psoriasis compared to a patient without psoriasis with a relative risk (RR) of 1.21. Among the pooled patients with mild psoriasis, the RR of all-cause mortality was 1.13 and among the pooled patients with severe psoriasis, the RR was 1.52.

The researchers also reviewed cause-specific mortality in patients with psoriasis. Surprisingly the comorbid conditions associated with the highest relative risk in patients with psoriasis were renal and liver disease.

The RR of mortality associated with renal disease in patients with psoriasis compared to patients without was an astounding 2.16, 2.20 in patients with mild disease and, 3.54 in patients with severe disease. Similarly, the RR of mortality associated with liver disease in patients with psoriasis compared to patients without psoriasis was 2.00, in patients with mild disease 4.26 and 3.97 in patients with severe disease.

The RR for cardiovascular mortality was 1.15 in patient with psoriasis compared to patients without psoriasis. However, in mild psoriasis the RR was only 1.05 while in severe psoriasis it was 1.38. The RR mortality from infections in patients with psoriasis compared to patients without psoriasis was 1.24, 1.41 in mild disease, and  1.58 in patients with severe psoriasis.

While this study highlights the increase in mortality in patients with psoriasis, the authors acknowledge that understanding the mechanisms governing the increase in mortality will be key to improving outcomes in patients suffering from psoriasis.

Reference
Dhana A, Yen H, Yen H, Cho E. All-cause and cause-specific mortality in psoriasis: a systematic review and meta-analysis. Journal of the American Academy of Dermatology. 2018 Dec 24.