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

Br J Dermatol. 2009 Nov;161(5):1149-52. doi: 10.1111/j.1365-2133.2009.09350.x. Epub 2009 Jun 11.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Odds Ratio
  • Pemphigoid, Bullous / complications*
  • Pemphigoid, Bullous / mortality
  • Pneumonia / epidemiology*
  • Pulmonary Embolism / epidemiology*
  • Risk Factors
  • Sepsis / epidemiology*
  • United Kingdom
  • Young Adult