Analysis Of The Prognostic Factors In Bullous Pemphigoid

Objective: To analyze the prognostic factors of patients with bullous pemphigoid(BP)by systematic review and clinical research,so as to provide a certain reference basis for clinical treatment and improvement of prognosis.Methods: Part Ⅰ: PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,China Biology Medicine disc and Wanfang Database were searched to collect the published literature on the prognostic factors of BP patients.Mortality was defined as an outcome indicator.Literature screening,quality assessment and data extraction were conducted by two researchers independently.The systematic review was performed by the Review Manager 5.4 and Stata 14.0 software.Part Ⅱ: BP patients diagnosed from January 1,2016 to September 30,2019 in the Inpatient Department of Dermatology,Lanzhou University Second Hospital were retrospectively analyzed.The SPSS 25.0 statistical software was used.The one year mortality was estimated by Kaplan-Meier survival curve method.The related factors affecting the mortality of BP patients were analyzed by Cox proportional hazard model.Results: Part Ⅰ: 15 studies involving 2,435 patients were included.The systematic review showed that the mortality of BP patients increased with advanced age(HR=1.36,95%CI: 1.20–1.54,P<0.001);poor general condition(HR= 2.14,95%CI:1.06–4.29,P=0.03);positive bullous pemphigoid 180 antibody(HR=1.85,95%CI:1.25–2.75,P=0.002)and concomitant dementia(HR=2.26,95%CI: 1.43–3.59,P<0.005);stroke(HR=2.09,95%CI: 1.23–3.55,P=0.007);heart disease(HR=1.96,95%CI: 1.41–2.73,P<0.001)and diabetes mellitus(HR=2.39,95%CI: 1.55–3.69,P<0.001).There was no statistical significance between sex,disease severity,positive indirect immunofluorescence,concomitant hypertension and the mortality of BP patients(P>0.05).Part Ⅱ: A total of 101 BP patients were included.The one year mortality was 14.85%.In univariate analysis,the factors that affects the mortality with statistical significance were advanced age,poor general condition,concomitant stroke,and heart diseases(P<0.05).Multivariate analysis showed that advanced age(HR=6.57,95%CI: 1.85～23.35,P=0.004),poor general condition(HR=3.56,95%CI:1.12～11.33,P=0.031),and concomitant stroke(HR=3.15,95%CI: 1.06～9.38,P=0.04)increased the mortality of BP patients.Conclusion: Part Ⅰ: Advanced age,poor general condition,positive bullous pemphigoid 180 antibody,concomitant dementia,stroke,heart disease and diabetes mellitus were the poor prognostic factors in BP patients.Sex,disease severity,positive indirect immunofluorescence and concomitant hypertension were not associated with prognosis.Part Ⅱ: The one year mortality of BP patients was 14.85%.The poor prognostic factors in BP patients were advanced age,poor general condition,and concomitant stroke.