Background

Venous thromboembolism (VTE) is a common medical problem with high morbidity and mortality. Although chronic inflammation was not categorized as a traditional risk factor for VTE, chronic inflammation might increase the risk to develop a VTE event.

While studies confirmed an increased cardiovascular morbidity and mortality in psoriatic patients, data about influence of psoriasis on patients‘ cardiovascular profile and on prognosis of patients with pulmonary embolism (PE) are sparse.

Methods

PE patients with and without psoriasis were analysed regarding cardiovascular profile and in-hospital outcome. The present study is based on data from the German nationwide inpatient sample 2005-2017 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2017, own calculations).

Results

The analysis comprised a total number of 1,076,384 hospitalizations of PE patients (53.7% females, 54.0% aged ≥70years) in Germany 2005-2017. Among these, 3,145 were coded with psoriasis (0.3%). Overall, 172,287 patients with PE died during the hospitalization (16.0%). While the total numbers of PE patients with psoriasis increased over time from 205 in the year 2005 to 279 in the year 2017 (β 6.4 [95%CI 4.0 to 8.7], P<0.001), mortality rate of PE patients with psoriasis remained statistically unchanged (β -0.23 [95%CI -0.66 to 0.20], P=0.294).

PE patients with additional psoriasis were younger (68.0 (IQR 57.0-76.0) vs. 72.0 (60.0-80.0) years, P<0.001) and more often of male sex (64.1% vs. 46.3%, P<0.001). All investigated traditional cardiovascular risk factors such as essential arterial hypertension (49.8% vs. 43.1%, P<0.001), diabetes mellitus (24.4% vs. 18.7%, P<0.001), hyperlipidaemia (14.1% vs. 12.0%, P<0.001), smoking (5.9% vs. 2.7%, P<0.001), as well as obesity (19.6% vs. 9.6%, P<0.001) and atherosclerotic comorbidities like coronary artery disease (15.2% vs. 13.8%, P=0.022) and peripheral artery disease (3.6% vs. 2.9%, P=0.010) were more prevalent in PE patients with psoriasis.  
The risk stratification markers right ventricular dysfunction (27.9% vs. 29.0%, P=0.213) and shock (3.8% vs. 3.8%, P=0.805) were similarly prevalent in both groups. Revascularization treatments such as systemic thrombolysis (P=0.924) and surgical embolectomy (P=0.537) were not more often used in one study group.

PE patients with psoriasis showed a significantly lower in-hospital case-fatality rate (11.1% vs. 16.0%, P<0.001), confirmed in the multivariable logistic regression model adjusted for age, sex and comorbidities (OR 0.72 [95%CI 0.65-0.81], P<0.001).

While the necessity regarding transfusion of blood constituents was higher in psoriatic PE patients (OR 1.24 [95%CI 1.12-1.38], P<0.001), the risk to develop a shock during hospitalization was lower in PE patients with psoriasis than in those without (OR 0.80 [95%CI 0.73-0.88], P<0.001).

Conclusions

Overall, only 0.3% of all PE cases were coded additionally with psoriasis. PE events in patients with psoriasis occurred in median 4 years earlier in life than in those PE patients without psoriasis. Psoriasis was associated with increased prevalence of classical cardiovascular risk factors and atherosclerosis. Our data reveal a substantially lower in-hospital mortality rate in psoriatic PE patients, which might be mainly driven by the younger age and lower risk regarding development of haemodynamic instability.