Bullous pemphigoid is an autoimmune disease with dermal blistering that tends to occur in the elderly. Roujeau et al identified risk factors with death within 6 months of presentation. The authors are from the University Paris XII, University of Amiens and the University of Limoges in France.
Parameters affecting short term mortality (within 6 months):
(1) age
(2) general physical condition
(3) gender
(4) extent of disease
|
Parameter |
Finding |
Points |
|
age |
<= 75 years |
0 |
|
|
76 - 85 years |
2 |
|
|
>= 86 years |
3 |
|
general physical condition |
excellent to good |
0 |
|
|
fair |
1 |
|
|
poor |
3 |
|
gender |
male |
0 |
|
|
female |
1 |
|
extent of bullous pemphigoid |
localized |
0 |
|
|
generalized |
2 |
where:
• NOTE: The points assigned are based on the relative risk for a finding divided by the relative risk for the factor with the lowest value (female gender). This is not the approach used by the authors of the paper.
• An alternative to a simple sum would be to multiply the relative risk factors (4-6 and 7.1 for age, 8.2 for general condition, 2.4 for gender and 4.4 for general disease; see Table 3, page 467).
• I added 1 point for a fair general physical condition.
• Rzany et al (previous section) found that male gender was a risk factor for death after 3 years from first hospitalization.
• A major cause of death was sepsis.
• Most patients received corticosteroids. Corticosteroids were more likely to be used and to be used in higher doses in patients with generalized disease.
• About 9% of patients were reported to have cancer (19 out of 215).
total number of risk factors for short-term mortality =
= SUM(points for all 4 parameters)
Interpretation:
• minimum risk score: 0
• maximum risk score: 9
• The higher the score the greater the risk of short term mortality.
Limitations:
• The score in the implementation is a departure from the original study and needs to be validated.
Specialty: Dermatology
