Survival Analysis Of 109 Patients With Bullous Pemphigoid

Background and objectives: Bullous pemphigoid(BP)patients reported in different countries have different mortality and prognosis factors.The purpose of this study was to count the mortality and disease-related factors in hospitalized patients with BP in the first year after diagnosis,and to analyze the prognostic factors that influence overall survival.Methods: This study uses research methods for survival analysis,BP patients who were diagnosed for the first time in the dermatology ward of the Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from January 1,2015 to January 31,2018.Through the hospital case search system,we reviewed the medical records of 109 inpatients with BP.Use Microsoft Excel software to design surveys,enter data,and build databases.Patients or their families were followed up by telephone to obtain relevant information.The date of diagnosis of BP patients was used as the starting point of observation,and the date of death was used as the end point of observation.The date of follow-up was January 31,2019.It was determined to be censored data after loss of follow-up and survival at the last follow-up.The survival time is in months.Statistical analysis was performed using SPSS18.0 software,and the survival curve was drawn using graphpad prism 5 software.The cumulative mortality was estimated using the Kaplan-Meier method and the survival curve was obtained.Univariate analysis was performed by log-rank test,statistically significant factors were selected and analyzed using a multivariate COX proportional hazards model to explore factors affecting the prognosis of BP patients.The hazard ratio(HR)was estimated using a 95% confidence interval(CI).p < 0.05 was considered statistically significant.Results: 1.Demographic data and clinical features 1.1 Demographic data: A total of 109 eligible BP patients were enrolled in the study,63(57.8%)were male,and 46(42.2%)were female.The mean age at diagnosis was(71.9 ± 9.4)years.The age range at the time of diagnosis is 43 to 90 years old.Sixteen patients were lost to follow-up,and the rate of loss of follow-up was 14.7%.1.2 Clinical features: The first site of BP patients is most common in the trunk and limbs.The first lesions are most common with blisters and/or bullae,18.3% of the patients with mucosa,and the rate of misdiagnosis is 53.2%.Hemoglobin concentration,eosinophil ratio,serum albumin,serum calcium,fibrinogen concentration,D-dimer,complement 3,immunoglobulin M,immunoglobulin A,immunoglobulin G and so on in laboratory examination of patients with BP have varying degrees of change.The combined diseases were mainly hypertension(45.9%),diabetes(15.6%),heart disease(14.7%),and cerebrovascular disease(13.8%).2.The one-year mortality rate of BP patients was 10.1%(95% CI,4.1-16.1).3.In the univariate analysis of the prognosis of patients with BP,the statistically significant(p<0.05)factors were age,combined cerebrovascular disease,hemoglobin concentration,serum albumin,serum calcium,fibrinogen concentration,and dose of glucocorticoid.4.In multivariate analysis,the prognostic factors affecting BP patients were age,hemoglobin concentration,and cerebrovascular disease.The regression coefficient(B)was >0,and the Exp(B)risk factors were all >1.Disease,age greater than 80 years,decreased hemoglobin concentration,are independent predictive risk factors affecting the survival rate of BP patients.Conclusion: 1.In this study,BP mostly occurred in the elderly over 60 years old.2.The early clinical manifestations of BP patients are diverse,and should be differentiated based on medical history,clinical manifestations,pathological features and immunofluorescence results to reduce missed diagnosis and misdiagnosis.Laboratory parameters such as eosinophil ratio,coagulation function,and serum albumin in BP patients have different degrees of changes,and should be reviewed.The general use of BP patients in the treatment of systemic glucocorticoids,so should pay attention to reduce the complications of systemic treatment.3.This study showed that the one-year mortality rate of BP patients was 10.1%.This number is lower than other studies.4.The diagnosis of advanced age,cerebrovascular disease,and decreased hemoglobin concentration are the main independent factors associated with poor prognosis of BP patients,it has certain reference value for clinical judgment of prognosis of BP patients.At the same time,clinicians are also reminded to treat elderly BP patients who are generally in poor condition with external or low-dose glucocorticoids.