 |
|
High Risk of Death in Elderly Patients With Extensive Bullous Pemphigoid
Jean-Claude Roujeau, MD;
Catherine Lok, MD;
Sylvie Bastuji-Garin, MD;
Sami Mhalla, MD;
Véronique Enginger, MD;
Philippe Bernard, MD
Arch Dermatol. 1998;134:465-469.
Objective To evaluate survival and factors predicting death in bullous pemphigoid.
Design Retrospective analysis of cohort.
Setting Three referral centers (university hospitals).
Patients Among 237 patients recruited between January 1, 1985, and December 31, 1992, 20 were excluded because of doubtful diagnosis. The 217 remaining patients were 79±11 years old (mean±SD); 120 were women and 97 were men; and 79% had been treated with oral corticosteroids, 40 to 90 mg/d.
Interventions Missing information on follow-up was minimized by letters and/or telephone calls to patients, families, nursing homes, and physicians.
Main Outcome Measures Actuarial survival curve, compared with the expected curve as derived from census data, and evaluation of prognostic factors by comparing initial characteristics between patients alive at 6 months and these who died before that point.
Results Survival curve demonstrated an early increased mortality: 17% at 3 months and 31% at 6 months, mainly from sepsis and cardiovascular diseases. Of the factors related to bullous pemphigoid activity (duration; pruritus; and number and extent of blisters, eosinophilia, and serum antibodies) only generalized pemphigoid was predictive of death in comparison with localized forms. In multivariate analysis, age of 86 years or more (relative risk, 7.1; 95% confidence interval [CI], 2.0-25.4; P .01), poor general condition (relative risk, 8.2; 95% CI, 3.0-22.4; P.001), female sex (relative risk, 2.4; 95% CI, 1.1-5.4; P.05), and generalized disease (relative risk, 4.4; 95% CI, 1.4-13.7; P.01) were associated with increased risks of death at 6 months.
Conclusion In this series, generalized bullous pemphigoid had a poor prognosis especially in older patients and those in poor general condition.
From the Departments of Dermatology (Drs Roujeau and Mhalla) and Public Health (Dr Bastuji-Garin), University Paris XII, Créteil; Department of Dermatology, University of Amiens, Amiens (Dr Lok); and Department of Dermatology, University of Limoges, Limoges (Drs Enginger and Bernard), France.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
A Retrospective Analysis of Patients With Bullous Pemphigoid Treated With Methotrexate
Kjellman et al.
Arch Dermatol 2008;144:612-616.
ABSTRACT
| FULL TEXT
A Comparison of Oral Methylprednisolone Plus Azathioprine or Mycophenolate Mofetil for the Treatment of Bullous Pemphigoid
Beissert et al.
Arch Dermatol 2007;143:1536-1542.
ABSTRACT
| FULL TEXT
Prediction of Survival for Patients With Bullous Pemphigoid: A Prospective Study
Joly et al.
Arch Dermatol 2005;141:691-698.
ABSTRACT
| FULL TEXT
Oral and Topical Corticosteroids in Bullous Pemphigoid
Korman et al.
NEJM 2002;347:143-145.
FULL TEXT
Risk Factors for Lethal Outcome in Patients With Bullous Pemphigoid: Low Serum Albumin Level, High Dosage of Glucocorticosteroids, and Old Age
Rzany et al.
Arch Dermatol 2002;138:903-908.
ABSTRACT
| FULL TEXT
A Comparison of Oral and Topical Corticosteroids in Patients with Bullous Pemphigoid
Joly et al.
NEJM 2002;346:321-327.
ABSTRACT
| FULL TEXT
Bullous Pemphigoid Therapy -- Think Globally, Act Locally
Stern
NEJM 2002;346:364-367.
FULL TEXT
Bullous Pemphigoid: The Latest in Diagnosis, Prognosis, and Therapy
Korman
Arch Dermatol 1998;134:1137-1141.
FULL TEXT
|
