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      Risk of Incident Venous Thromboembolism Among Patients With Bullous Pemphigoid or Pemphigus Vulgaris: A Nationwide Cohort Study With Meta‐Analysis

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          Abstract

          Background

          Bullous pemphigoid (BP) and pemphigus vulgaris (PV) share similar pathophysiology with venous thromboembolism (VTE) involving platelet activation, immune dysregulation, and systemic inflammation. Nevertheless, their associations have not been well established.

          Methods and Results

          To examine the risk of incident VTE among patients with BP or PV, we performed a nationwide cohort study using Taiwan's National Health Insurance Research Database and enrolled 12 162 adults with BP or PV and 12 162 controls. A Cox regression model considering stabilized inverse probability weighting was used to calculate the hazard ratios (HRs) for incident VTE associated with BP or PV. To consolidate the findings, a meta‐analysis that incorporated results from the present cohort study with previous literature was also conducted. Compared with controls, patients with BP or PV had an increased risk for incident VTE (HR, 1.87 [95% CI, 1.55–2.26]; P<0.001). The incidence of VTE was 6.47 and 2.20 per 1000 person‐years in the BP and PV cohorts, respectively. The risk for incident VTE significantly increased among patients with BP (HR, 1.85 [95% CI, 1.52–2.24]; P<0.001) and PV (HR, 1.99 [95% CI, 1.02–3.91]; P=0.04). In the meta‐analysis of 8 studies including ours, BP and PV were associated with an increased risk for incident VTE (pooled relative risk, 2.17 [95% CI, 1.82–2.62]; P<0.001).

          Conclusions

          BP and PV are associated with an increased risk for VTE. Preventive approaches and cardiovascular evaluation should be considered particularly for patients with BP or PV with concomitant risk factors such as hospitalization or immobilization.

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          Most cited references72

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Measuring inconsistency in meta-analyses.

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              A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

              The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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                Author and article information

                Contributors
                drhkhuang@gmail.com
                chingchi@cgmh.org.tw
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                29 August 2023
                05 September 2023
                : 12
                : 17 ( doiID: 10.1002/jah3.v12.17 )
                : e029740
                Affiliations
                [ 1 ] Department of Dermatology Taipei Veterans General Hospital Taipei Taiwan
                [ 2 ] Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Hualien Taiwan
                [ 3 ] Epidemiology and Biostatistics Center, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Hualien Taiwan
                [ 4 ] Center for Aging and Health Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Hualien Taiwan
                [ 5 ] School of Medicine Tzu Chi University Hualien Taiwan
                [ 6 ] Department of Family Medicine Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Hualien Taiwan
                [ 7 ] Department of Medical Research, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Hualien Taiwan
                [ 8 ] Department of Dermatology Chang Gung Memorial Hospital, Linkou Taoyuan Taiwan
                [ 9 ] School of Medicine College of Medicine, Chang Gung University Taoyuan Taiwan
                Author notes
                [*] [* ] Correspondence to: Ching‐Chi Chi, Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan 33305, Taiwan. Email: chingchi@ 123456cgmh.org.tw

                Huei‐Kai Huang, Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Chung Yang Rd, Hualien 97002, Taiwan. Email: drhkhuang@ 123456gmail.com .

                [*]

                H. K. Huang and C. C. Chi contributed equally.

                Author information
                https://orcid.org/0000-0002-5761-8114
                https://orcid.org/0000-0002-6839-1365
                https://orcid.org/0000-0002-3324-0962
                https://orcid.org/0000-0003-3612-653X
                https://orcid.org/0000-0001-5699-0283
                Article
                JAH38545 JAHA/2023/029740-T
                10.1161/JAHA.123.029740
                10547313
                37642024
                3d7fa470-a7ed-4865-b40a-72e3d3d667ea
                © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 07 February 2023
                : 15 May 2023
                Page count
                Figures: 2, Tables: 3, Pages: 10, Words: 6277
                Funding
                Funded by: Hualien Tzu Chi Hospital
                Award ID: TCRD108‐21
                Categories
                Original Research
                Original Research
                Epidemiology
                Custom metadata
                2.0
                05 September 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.3 mode:remove_FC converted:04.09.2023

                Cardiovascular Medicine
                bullous pemphigoid,cohort study,meta‐analysis,pemphigus vulgaris,systematic review,venous thromboembolism,epidemiology,big data and data standards,meta analysis,embolism,thrombosis

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