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Abstract：
BACKGROUND: Prurigo nodularis (PN) presents with intensely itchy hard nodules. Despite being limited to the skin, PN was noted to be associated with systemic diseases including diabetes and chronic renal failure. In previous smaller retrospective studies, several cardiac and vascular diseases were found more frequently in patients with PN. However, small cohort sizes, partially discrepant outcomes, missing data, and incomplete risk assessment limit these findings.
METHODS: Electronic health records (EHR)s of 64,801 patients (59.44% females) with PN and an equal sized propensity-matched control group were retrieved. In these cohorts, the risks to develop cardiac and vascular diseases and mortality following the diagnosis of PN were determined. Sub-analyses included stratification for sex, ethnicity, and treatments.
RESULTS: PN was associated with a higher risk for a broad range of acute cardiac events including heart failure and myocardial infarction. For example, the hazard ratio of myocardial infarction was 1.11 (95%-CI: 1.041-1.184, p = 0.0015) following PN diagnosis. Also, all-cause mortality was higher in patients with PN. Further, chronic vascular as well as structural heart diseases, e.g., peripheral arterial disease, chronic ischaemic heart disease and valval disorders were found more frequently following a PN diagnosis. Risks were more pronounced in white and female patients. Having established an increased risk for death and cardiovascular disease, we next addressed if dupilumab that has been recently licenced for use in this indication can modulate these risks. The risk of death but not of any cardiovascular disease was slightly reduced in patients with PN treated with dupilumab as opposed to those treated with systemic therapies other than dupilumab. The study is limited by retrospective data collection and reliance on ICD10-disease classification.
CONCLUSIONS: PN is associated with higher mortality and an increased risk for the development of a wide range of cardiac and vascular diseases. Health care professionals should take this into account when managing patients with PN.
BACKGROUND: This work was supported by the University of Lübeck, the Deutsche Forschungsgemeinschaft and the State of Schleswig-Holstein.
METHODS: Electronic health records (EHR)s of 64,801 patients (59.44% females) with PN and an equal sized propensity-matched control group were retrieved. In these cohorts, the risks to develop cardiac and vascular diseases and mortality following the diagnosis of PN were determined. Sub-analyses included stratification for sex, ethnicity, and treatments.
RESULTS: PN was associated with a higher risk for a broad range of acute cardiac events including heart failure and myocardial infarction. For example, the hazard ratio of myocardial infarction was 1.11 (95%-CI: 1.041-1.184, p = 0.0015) following PN diagnosis. Also, all-cause mortality was higher in patients with PN. Further, chronic vascular as well as structural heart diseases, e.g., peripheral arterial disease, chronic ischaemic heart disease and valval disorders were found more frequently following a PN diagnosis. Risks were more pronounced in white and female patients. Having established an increased risk for death and cardiovascular disease, we next addressed if dupilumab that has been recently licenced for use in this indication can modulate these risks. The risk of death but not of any cardiovascular disease was slightly reduced in patients with PN treated with dupilumab as opposed to those treated with systemic therapies other than dupilumab. The study is limited by retrospective data collection and reliance on ICD10-disease classification.
CONCLUSIONS: PN is associated with higher mortality and an increased risk for the development of a wide range of cardiac and vascular diseases. Health care professionals should take this into account when managing patients with PN.
BACKGROUND: This work was supported by the University of Lübeck, the Deutsche Forschungsgemeinschaft and the State of Schleswig-Holstein.
摘要：
背景：结节性痒疹（PN）表现为强烈发痒的硬结节。尽管仅限于皮肤，注意到PN与包括糖尿病和慢性肾衰竭在内的全身性疾病有关。在以前较小的回顾性研究中，在PN患者中发现几种心脏和血管疾病更为常见。然而,小队列大小，部分不同的结果，缺少数据，和不完整的风险评估限制了这些发现。
方法：检索了64,801例PN患者（59.44％女性）和同等规模的倾向匹配对照组的电子健康记录（EHR）。在这些队列中，确定了PN诊断后发生心血管疾病的风险和死亡率.分分析包括性别分层，种族,和治疗。
结果：PN与包括心力衰竭和心肌梗死在内的各种急性心脏事件的高风险相关。例如,在PN诊断后,心肌梗死的风险比为1.11(95%-CI:1.041-1.184,p=0.0015).此外，PN患者的全因死亡率较高.Further,慢性血管和结构性心脏病,例如，外周动脉疾病,慢性缺血性心脏病和瓣膜疾病在PN诊断后更常见.白人和女性患者的风险更为明显。已经确定了死亡和心血管疾病的风险增加，我们接下来讨论了最近被批准用于该适应症的dupilumab是否可以调节这些风险.与接受dupilumab治疗的PN患者相比，接受dupilumab治疗的患者的死亡风险略有降低，但没有任何心血管疾病的风险。该研究受到回顾性数据收集和对ICD10疾病分类的依赖的限制。
结论：PN与更高的死亡率和发生多种心脏和血管疾病的风险增加相关。卫生保健专业人员在管理PN患者时应考虑到这一点。
背景：这项工作得到了吕贝克大学的支持，德意志论坛和石勒苏益格-荷尔斯泰因州。
方法：检索了64,801例PN患者（59.44％女性）和同等规模的倾向匹配对照组的电子健康记录（EHR）。在这些队列中，确定了PN诊断后发生心血管疾病的风险和死亡率.分分析包括性别分层，种族,和治疗。
结果：PN与包括心力衰竭和心肌梗死在内的各种急性心脏事件的高风险相关。例如,在PN诊断后,心肌梗死的风险比为1.11(95%-CI:1.041-1.184,p=0.0015).此外，PN患者的全因死亡率较高.Further,慢性血管和结构性心脏病,例如，外周动脉疾病,慢性缺血性心脏病和瓣膜疾病在PN诊断后更常见.白人和女性患者的风险更为明显。已经确定了死亡和心血管疾病的风险增加，我们接下来讨论了最近被批准用于该适应症的dupilumab是否可以调节这些风险.与接受dupilumab治疗的PN患者相比，接受dupilumab治疗的患者的死亡风险略有降低，但没有任何心血管疾病的风险。该研究受到回顾性数据收集和对ICD10疾病分类的依赖的限制。
结论：PN与更高的死亡率和发生多种心脏和血管疾病的风险增加相关。卫生保健专业人员在管理PN患者时应考虑到这一点。
背景：这项工作得到了吕贝克大学的支持，德意志论坛和石勒苏益格-荷尔斯泰因州。
