A population-based study of acute medical conditions associated with bullous pemphigoid

Background Bullous pemphigoid is associated with poorly understood dramatically increased early mortality rates. Objectives To assess the incidence of acute events predisposing to early mortality. Methods Computerized medical records from the Health Improvement Network, a large population-based U.K. general practice database, were used to conduct a cohort analysis. Outcome measures were incidence rates of myocardial infarction, pulmonary embolism, pneumonia and sepsis compared with a matched control population. Results People with bullous pemphigoid were three times as likely to develop pneumonia, adjusted rate ratio 2·94 [95% confidence interval (CI) 2·01-4·31] or pulmonary embolism, adjusted rate ratio 3·12 (95% CI 1·37-7·12) compared with matched controls. No statistically significant increase was seen for myocardial infarction, adjusted rate ratio 1·24 (95% CI 0·66-2·33), or sepsis, adjusted rate ratio 2·02 (95% CI 0·78-5·21). Conclusions The risk of pulmonary embolism and pneumonia is increased following a diagnosis of bullous pemphigoid. It may be possible to reduce associated mortality through considering prophylaxis with either antithromboembolic measures or antibiotic therapy and vaccination.