Generalized pustular psoriasis (GPP) is a rare heterogeneous cutaneous disease characterized by multiple flares of painful pustules with widespread inflammation. 1 Chronic systemic inflammation in GPP may result in anaemia by mechanisms such as iron sequestration in macrophages. 2 Lee et al. 3 demonstrated an increased risk of psoriasis in chronic kidney disease patients with low haemoglobin levels. Though some level of associations between anaemia and GPP has been previously considered, we sought to evaluate whether the presence of anaemia was associated with adverse inpatient outcomes in patients hospitalized with GPP.We reviewed the National Inpatient Sample, a publicly available, de-identified database of US hospital encounters produced by the Agency for Healthcare Research and Quality (AHRQ), from the years 2016 to 2020. GPP diagnosis was identified by searching for International Classifications of Disease, 10th Edition (ICD-10-CM) code L40.1 (generalized pustular psoriasis) as a primary diagnosis.We utilized the AHRQ Elixhauser Comorbidity Software Refined (CMR) to identify deficiency anaemia comorbidity. A full list of ICD-10-CM codes categorized under deficiency anaemia can be viewed in Table S1. The CMR was used to search for the presence of leukaemia, lymphoma, metastatic cancer, solid tumor without metastasis and in situ/malignant. Demographic characteristics including age, sex, race, income, insurance status and outcome measures of length of hospital stay and cost of inpatient visit were collected. Cost was standardized between hospitals using cost-to-charge ratio files.Patients under the age of 18 were excluded. The sample was separated into cohorts by the presence or absence of a deficiency anaemia comorbidity. Univariate analysis was conducted between groups
Generalized pustular psoriasis (GPP) is a clinical entity distinct from psoriasis, associated with a poor clinical prognosis, often resulting in severe systemic complications and mortality. The relapsing nature of the disease with recurrent or intermittent flares imposes a significant burden on patients' quality of life (QoL). Although inadequately studied, QoL data in GPP patients has been a recent point of investigation. We conducted a literature search on PubMed/MEDLINE using the following search terms: ‘generalized pustular psoriasis’ OR ‘pustular psoriasis’ AND ‘quality of life’. We identified 12 relevant articles that provide insight into the large impact of GPP on the QoL of patients, the burden of the disease and the treatment, and the success of new treatment options in making a clinically important difference to QoL. This review illustrates a need for routine assessment of the QoL in interventional clinical trials for GPP and during physician encounters. This information can help guide clinicians on how to tailor the treatment approach from the patient's perspective or illustrate whether new therapies offer meaningful benefits to patient care as we enter an era of exciting new treatments for this challenging condition.
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