Analysis Of Clinical Data And Hospitalization Expenses Of 1178 Inpatients With Psoriasis

Objectives:In order to provide a scientific basis for improving the quality of life of patients with psoriasis and strengthening the prevention and treatment of severe psoriasis,a retrospective analysis was made on the clinical data of 1178 inpatients with psoriasis in the department of dermatology of a tertiary general hospital in Lanzhou,including family history,inducements,course of disease,clinical manifestations,comorbidities,examination findings and treatment methods,and the risk factors for the occurrence of severe psoriasis were assessed,so that the morbidity characteristics and clinical characteristics of psoriasis in Gansu area were clarified;In addition,the composition,changing trends and influencing factors of hospitalization expenses of patients with psoriasis were analyzed.Methods:The clinical data of 1178 patients with psoriasis who were hospitalized in the department of dermatology of a tertiary general hospital in Lanzhou from 2014 to 2020were collected.SPSS 25.0 statistical software was adopted to analyze the clinical characteristics of patients with psoriasis by descriptive statistics,non-parametric tests,and chi-square tests,and univariate analysis and multivariate logistic regression analysis were used to explore the risk factors of severe psoriasis.The level and composition of hospitalization expenses were obtained by descriptive analysis.The change trend of hospitalization days,total hospitalization expenses and individual expenses was analyzed by Kendall correlation test.The influencing factors of hospitalization expenses were explored by univariate analysis and multivariate logistic regression analysis.Results:1.Demographic characteristicsA total of 1178 inpatients with psoriasis were included,of whom 743（63.1%）were male and 435（36.9%）were female,and the proportion of men and women was1.71:1.The mean age was 37.14±17.94 years old,the mean age of onset was 27.26±15.17 years old,and the peak period of onset was 20～29 years old.There was no statistical difference in the age of onset between male and female patients（P=0.159）.2.Clinical features and observation indicators（1）A family history of psoriasis was present in 12.2%of patients,with earlier onset in those with a family history than in those without（P=0.015）.43.1%patients had clear inducing/aggravating factors in this onset.The upper respiratory tract infection（44.3%）and systemic use of glucocorticoid（15.7%）were the most common.The patients had a mean duration of psoriasis of 7.00（1.00,15.00）years,which was longer in men than in women（P=0.005）.（2）The research objects included 69.6%of patients with psoriasis vulgaris（PV）,14.2%of patients with pustular psoriasis（PP）,10.1%of patients with erythrodermic psoriasis（EP）and 6.1%of patients with psoriatic arthritis（PSA）.There were more female patients with PP and male patients with EP（P<0.001）,more patients under 40years old with PV and more over 40 years old with EP or PSA（P<0.001）.The severity of skin lesions in patients with EP was significantly higher than that with PP or PSA（P<0.001）.The positive rate of nail disorders was 23.2%,among which there were more patients with EP（47.9%）or PSA（43.1%）（P<0.001）.The positive rate of fascicular hair was 16.2%,with more patients with EP（24.4%）or PV（17.6%）（P<0.001）.The positive rate of tongue disorders was 11.3%,with more patients with EP（25.2%）or PP（16.2%）（P<0.001）.The positive rate of joint pain was 9.3%,among which patients with PSA was the most（59.7%）（P<0.001）.The positive rate of pharyngeal congestion/tonsil swelling was 10.3%,among which patients with PV was the most（11.8%）（P=0.033）.The incidence of fever was 13.2%,the ratio from high to low was EP（47.9%）,PP（41.9%）,PSA（11.1%）and PV（2.6%）（P<0.001）.66.7%of the patients had at least one comorbidity,mainly including metabolic diseases such as overweight/obesity（37.2%）,hyperlipidemia（21.1%）and infectious diseases such as upper respiratory tract infection（19.8%）,and the number of comorbidities increased with age（P<0.001）.10.5%of patients were misdiagnosed at the initial visit,and most of them were misdiagnosed as eczema（37.9%）.（3）During hospitalization,abnormal inflammatory indicators such as elevated PCT（36.7%）and elevated ASO（31.9%）,abnormal biochemical indexes such as elevated TG（21.1%）and elevated LDH（17.7%）,and abnormal immune-related indexes such as decreased Ig G（38.0%）and elevated C4（32.6%）were common in patients with psoriasis.The positive rate of throat swab examination was 11.6%,and the strains were predominantly Staphylococcus aureus（35.6%）and Klebsiella pneumoniae（27.1%）.Among the four clinical phenotypes,PP had higher rates of elevation rate of WBC（31.5%,P<0.001）,elevation rate of NE%（42.3%,P<0.001）and reduction rate of HGB（8.9%,P=0.017）;PV had higher rates of elevation rate of ASO（36.1%,P=0.012）,while reduction rate of elevation rate of CRP（19.9%,P<0.001）,elevation rate of ESR（29.6%,P<0.001）,elevation rate of PCT（49.1%,P<0.001）,reduction rate of Ca（4.2%.P<0.001）and reduction rate of HDL（3.6%,P=0.002）;And elevation rate of AMY was higher in EP（10.4%,P=0.012）.Skin histopathological examination was performed in 2.5%of the patients to confirm the diagnosis.Joint abnormalities were found in 6.3%of the patients,with synovitis（25.9%）and joint effusion（24.7%）being more common.For patients with PV and PSA,the utilization rate of adjuvant drugs（69.5%,70.8%,P<0.001）,phototherapy（61.0%,68.1%,P<0.001）and traditional Chinese medicine bath therapy（86.8%,69.4%,P=0.001）were higher.The immunosuppressant application of patients with EP was higher（45.4%,P=0.007）.The hospitalization time of patients with EP was the longest（11.10±3.71 days,P<0.001）,and the average number of days in hospital for patients with psoriasis tended to decrease gradually between 2014 to 2020(r_s=-0.048,P_trend=0.028).3.Risk factors for severe psoriasisAmong the collected cases,there were 375 patients（31.8%）with mild to moderate psoriasis and 803（68.2%）with severe psoriasis.Compared with patients with mild to moderate disease,for severe patients,the proportion of male patients was larger（P=0.001）,the average age（P<0.001）and the average age of onset（P<0.001）were older,the rate of married patients（P<0.001）,the rate of patients with high school/technical secondary school/junior college education（P<0.001）,and the rate of patients with smoking history（P=0.009）were higher;Most of the cases had clear inducements（P<0.001）,systematic administration of glucocorticoids（P<0.001）,withdrawal of immunosuppressants（P=0.006）and surgery or injury（P=0.020）were the main causes;There was no significant difference in the proportion of admissions between the four seasons（P=0.030）;The rate of patients experiencing relapse was higher（P=0.001）;The course of psoriasis was longer（P<0.001）;There were more symptoms such as nail disorders（P<0.001）,fascicular hair（P=0.030）,tongue disorders（P<0.001）,joint pain（P<0.001）and fever（P<0.001）,while the ratio of pharyngeal congestion/tonsil swelling was smaller（P=0.031）;There were more comorbidities（P<0.001）,and the incidence of overweight/obesity（P=0.017）,fatty liver（P=0.001）,gallstones/gallbladder polyps（P=0.004）and hepatic cysts/hepatic hemangioma/cirrhosis（P<0.001）were higher.Multivariate logistic regression analysis shows that males（OR=1.488,P=0.006）,with education level of junior high school or less（OR=2.099,P=0.002）,spring admission（OR=1.768,P=0.006）,summer admission（OR=1.511,P=0.034）,with clear inducements（OR=1.956,P<0.001）,with nail disorders（OR=1.795,P=0.003）,tongue disorders（OR=2.295,P=0.005）,joint pain（OR=4.226,P<0.001）,fever（OR=12.369,P<0.001）,one to two comorbidities（OR=1.485,P=0.017）,≥3 comorbidities（OR=1.664,P=0.027）and combined gallstones/biliary polyps（OR=11.162,P<0.001）,and combined liver cysts/hepatic hemangiomas/cirrhosis（OR=24.798,P=0.002）were independent risk factors for severe psoriasis.4.Composition,changing trends and influencing factors of hospitalization expensesIn the total hospitalization expenses of patients with psoriasis,28.89%for western medicine,25.52%for comprehensive treatment,and less than 15%for traditional Chinese medicine,bed space,nursing,diagnosis and other expenses.From 2014 to 2020,total hospitalization expenses(r_s=0.556,P_trend<0.012),examination and laboratory fees(r_s=0.096,P_trend<0.001),consultation fees(r_s=0.435,P_trend<0.001),and nursing fees(r_s=0.451,P_trend<0.001)adjusted by the Consumer Price Index（CPI）showed an increasing trend year by year;western medicine fees(r_s=-0.175,P_trend<0.001)and other fees(r_s=-0.417,P_trend<0.001)all showed a decreasing trend;There was no statistical significance in the change trends of comprehensive treatment fees(P_trend=0.064)and bed fees(P_trend=0.833).Multivariate logistic regression analysis showed that severe psoriasis（OR=1.547,P=0.022）,febrile symptoms（OR=1.518,P=0.024）,combined hypertension（OR=1.662,P=0.042）,and combined psychosomatic disorders（OR=3.200,P=0.043）would increase hospitalization expenses.Conclusions:1.The proportion of men and women in 1178 inpatients with psoriasis was 1.71:1,and the peak period of the onset was from age 20 to 29,68.2%of whom presented with severe psoriasis.Male gender,low education,induced by irrational use or withdrawal of drug,combination with overweight/obesity,hepatobiliary diseases and other systemic diseases,nail disorder,tongue disorder,joint pain,febrile symptoms were risk factors for severe psoriasis.2.The trend of total hospitalization expenses of psoriasis patients was on the rise between 2014 and 2020,and the expenses of examination and laboratory,western medicine and treatment accounted for a large proportion.Severe psoriasis,combination with hypertension and combination with psychosomatic diseases were major factors in increasing the total hospitalization expenses.