Psoriasis Linked to Device-Related Infective Endocarditis Risk Among Those with Pacemakers

Psoriasis is independently associated with increased risk of device-related infective endocarditis (IE) among individuals with permanent pacemakers (PPM), according to new findings, though additional research may be necessary for the purposes of assessing need for infective endocarditis prophylaxis.¹

These conclusions represented the findings of a recent study assessing data drawn from the National Inpatient Sample database. It was led by Chapman Wei, from the department of medicine at Northwell Health in New York.

Wei et al. noted that adverse cardiovascular outcomes are linked to psoriasis, citing myocardial infarction and stroke as examples. They added that dyslipidemia, hypertension, and atherosclerosis are more commonly seen among such patients versus the general population, though evidence was needed on risk of infective endocarditis.²

“There is currently limited evidence examining the association between psoriasis and IE,” Wei and colleagues wrote. “Considering that psoriasis is associated with increased skin infections, we sought to investigate the association between psoriasis and IE in patients with a history of PPM implantation.”

Background and Methods

The investigators chose to enroll individuals with a history of permanent pacemaker (PPM) implantation, selecting them from the National Inpatient Sample Database (2016–2018). The database was known to be the largest of its kind within the US and had been supported by the Healthcare Cost and Utilization Project (HCUP).

Baseline demographic information as well as comorbidities of patients included were found using International Classification of Diseases, 10th Revision (ICD-10) codes. IRB approval, according to the HCUP data use agreement, was not necessary for the research team as patient data had been anonymized.

Individuals under the age of 18 years or those with a history of central line-associated infections, immunosuppression, intravenous drug use, infective endocarditis, or implantable cardiac defibrillators were not included in the study. Study participants were categorized into 2 cohorts based on whether or not they had a diagnosis of psoriasis.

The investigators determined their main research outcome which would be assessed was the incidence of infective endocarditis in both of the study’s cohorts. The secondary outcomes they would evaluate would include rates of skin and soft tissue infections among participants.

The research team initially assessed outcomes through the use of univariate analysis, though this was later followed by multivariate analysis to determine the primary and secondary outcomes. The team adjusted their multivariate model for subject gender, age, and all baseline comorbidities.

For the purposes of ensuring comparability, both groups were matched based on gender, age, and listed comorbidities through the use of a 1:10,000 greedy propensity score matching with a caliper of 0.000001. Both the team’s primary and secondary outcomes were then assessed between the matched cohorts.

The investigators’ statistical analyses of the continuous variables was done through the use of student t-tests and ANOVA.

Findings

Overall, there was a total cohort of 437,793 individuals included in this study, with 45 having had diagnoses of psoriasis. Those who were shown to have psoriasis were reported by the research team to have demonstrated a far greater incidence of infective endocarditis, with 4.4% compared to 0.6%, respectively (P < .01).

The team’s multivariate analysis results showed that having psoriasis was linked to a major increase in risk of infective endocarditis, noting that there was an odds ratio of 7.2 (95% CI: 1.7–30.2; P < .01). Additionally, the investigators found that after matching for confounding variables, their research indicated that those with psoriasis were shown to have an 8.3-fold increased infective endocarditis risk (OR: 8.3 [95% CI: 2.0–34.4]; P < .001).

“In conclusion, psoriasis was associated with increased IE and skin/soft tissue infections in patients with PPM,” they wrote. “Psoriasis patients with PPM may benefit from antibiotic prophylaxis to prevent IE individually. Further large-scale studies are warranted to corroborate our findings and assess psoriasis patients with PPM for consideration of IE antibiotic prophylaxis.”

References

1. ^{Wei, C., Mustafa, N., Grovu, R., Wei, C., Rizvi, T., Bradu, S. and Mustafa, A. (2024), Impact of psoriasis on the risk of device-related infective endocarditis in patients with permanent pacemakers: a propensity-matched analysis. Int J Dermatol. https://doi.org/10.1111/ijd.17292.}
2. ^{Hu SC, Lan CE. Psoriasis and cardiovascular comorbidities: focusing on severe vascular events, cardiovascular risk factors and implications for treatment. Int J Mol Sci. 2017; 18(10):2211. https://doi.org/10.3390/ijms18102211.}