Patients With Pyoderma Gangrenosum and Higher Mortality Risk

All-cause mortality rates are higher among patients with pyoderma gangrenosum (PG) compared with the general population, according to results of a cohort study published in JAMA Dermatology.

Investigators from centers in South Korea sourced data for this study from the National Health Insurance Service (NHIS) database, which covers approximately 97% of the population in South Korea. Patients (n=3386) with PG who had 3 or more documented visits with medical facilities between 2003 and 2019 were matched in a 1:20 ratio with the general population without PG (n=67,720). Differences in all-cause and cause-specific mortality rates were compared between groups.

The PG and control cohorts comprised individuals with a mean age of 57.8 (SD, 16.4) years and 57.8 (SD, 16.3) years, 57.2% and 57.2% were men, and they had Charlson comorbidity index (CCI) scores of 3.65 and 3.23 points (P <.001), respectively.

Among the patients with PG, most had idiopathic disease (85.20%), followed by solid organ cancer-associated (10.01%), inflammatory bowel disease-associated (2.16%), rheumatoid arthritis-associated (1.54%), and hematological cancer-associated (1.09%) disease.

The PG group had lower survival rates at 5 (84.5% vs 93.8%), 10 (70.0% vs 84.2%), and 15 (53.1% vs 71.8%) years compared with controls, respectively.

All-cause mortality risk was associated with PG after adjusting for smoking, drinking, BMI, diabetes, and CCI (adjusted hazard ratio [aHR], 2.122; 95% CI, 1.971-2.285).

Similarly, PG was associated with increased risk for mortality from hematologic disease (aHR, 12.298), connective tissue or rheumatic disease (aHR, 8.685), endocrine disease (aHR, 6.322), infectious disease (aHR, 3.855), kidney or urogenital disease (aHR, 3.617), gastrointestinal disease (aHR, 2.278), neurologic disease (aHR, 2.039), cardiovascular disease (aHR, 1.979), respiratory disease (aHR, 1.757), and neoplasm or oncologic disease (aHR, 1.618), compared with the general population.

Among the 10 leading disease-specific causes of death, patients with PG were at higher risk for mortality from diabetes (aHR, 6.494), myocardial infarction (aHR, 3.043), liver cirrhosis (aHR, 2.645), pneumonia (aHR, 2.096), and ischemic stroke (aHR, 1.937) compared with the general population.

Stratified by PG etiology, risk for all-cause mortality was highest compared with the general population among patients with hematologic cancer-associated PG (aHR, 8.330), followed by solid organ cancer-associated PG (aHR, 2.313) and idiopathic PG (aHR, 2.062).

Results from the sensitivity analysis which restricted the PG group to only patients who were diagnosed at a tertiary referral center were consistent with the main analysis.

This study may be limited by not comparing mortality risk with other chronic ulcerative lesion conditions.

“To improve the long-term prognosis, a multidisciplinary approach might be required because PG is associated with various systemic diseases and is not a local disease that is confined to the skin,” the researchers wrote.