Psoriasis patients with cardiovascular comorbidity characterised by high systemic inflammation

A cohort study revealed that the novel biomarker systemic immune-inflammation index (SII), associated with a worse prognosis in different disease entities, was markedly elevated in psoriasis patients with concomitant cardiovascular comorbidity. There was a weak but significant correlation with the Psoriasis Area and Severity Index (PASI) but no correlation with smoking status.

“The systemic immune inflammation (SII) index is a simple calculation of neutrophils multiplied by platelets divided by lymphocytes,” Dr Niamh Kearney (St. Vincent’s University Hospital, Ireland) explained [1]. The SII has proven to be a promising prognostic indicator in various cancers, COVID-19 and other diseases. In patients with coronary artery disease, this index provides a better prediction of major cardiovascular events than traditional risk factors [2]. Severe psoriasis is associated with a distinct risk elevation for cardiovascular events and death. With their retrospective cohort study, Dr Kearny and her team wanted to assess whether SII is increased in psoriasis, particularly in psoriasis patients with cardiovascular comorbidities. They also aimed to quantify the SII in psoriasis and stratify it by the presence of diabetes, hypertension, dyslipidaemia, and coronary artery disease. They analysed electronic and physical records from specialty psoriasis clinics. “We looked at demographics, treatments, full blood count, and C-reactive protein results,” Dr Kearney explained. Patients on methotrexate were excluded from the study.

The analysis included data from 73 patients. Most patients were on a biologic and were smokers. Dyslipidaemia was the most common comorbidity prevalent in 12.3% of patients, followed by hypertension in 11% of patients. The mean c-reactive protein (CRP) for patients with cardiovascular comorbidities was 5.01 mg/L compared with 3.53 mg/L without comorbidities (P=0.046).

The researchers found a modest correlation between the CRP concentrations and the SII (r=0.530; P<0.001), and a weak significant correlation between the PASI and SII (r=0.299; P=0.011). However, no difference was observed in smokers, ex-smokers, and never smokers. Psoriasis patients with comorbidity (i.e. diabetes, hypertension, dyslipidaemia, or coronary artery disease) had an SII of 859.74 compared with 612.04 (P=0.014) in patients without comorbidity. In the individual comorbidity analysis, only hypertension was associated with a higher CRP of 7.4 mg/L (P<0.001) and an SII of 1038.05 (P=0.004).

The limitations of the study were the small number of patients with comorbidities and the lack of imaging data to confirm the association. Despite this, the authors think that the SII might have a role in risk stratification for primary and secondary prevention in psoriasis patients.

 

1. 
   
   1. Kearney N, et al. Systemic immune inflammation index as a predictor of systemic inflammatory burden and cardiovascular comorbidities in psoriasis. FC23, Psoriasis from Gene to Clinic 2021, 9–11 December.
   
   
   2. Yang YL, et al. Eur J Clin Invest 2020;50:e13230.

 

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Posted on 2 February, 2022