Association of pemphigus vulgaris with infections in end-stage renal disease patients

Background: Pemphigus vulgaris is an autoimmune, blistering disease. The bullae of pemphigus vulgaris are characteristically flaccid and rupture easily leaving behind areas of exposed, unprotected tissue. Due to this compromise in the skin barrier, pemphigus vulgaris may be an independent risk factor for developing infections in end-stage renal disease (ESRD) patients, who are already at increased risk of infection. Methods: A retrospective cohort analysis of ESRD patients entered into the United States Renal Data System between 2004 and 2019 was conducted. We evaluated the association of pemphigus vulgaris and the infections bacteremia, septicemia, cellulitis, and herpes zoster in this population. ICD-9-CM and ICD-10-CM codes were used to determine pemphigus vulgaris and infection diagnoses. Logistic regression was used to examine the association of pemphigus vulgaris with each infection. Results: A total of 150 patients with a diagnosis of pemphigus vulgaris after the incident date of dialysis were identified. The unadjusted model demonstrated that patients with pemphigus vulgaris are at a significantly increased risk of developing bacteremia, septicemia, cellulitis, and herpes zoster compared to those without pemphigus vulgaris. After controlling for covariates the association was still greater than 1 for each infection; however, the p-values became non-significant. Diabetes was found to be a confounding variable for the association of pemphigus vulgaris and each infection. Conclusion: These results determined that in the ESRD population, after controlling for various demographic and clinical covariates, pemphigus vulgaris was not associated with increased risk of the queried infections.