Bidirectional Inflammatory Mechanisms and Hematological/Coagulation Dysregulation in Psoriasis Complicated with Atherosclerosis: A Retrospective Hospital-Based Case-Control Study Leveraging the SH-YIMED Clinical Database.

BACKGROUND

Psoriasis is a chronic inflammatory skin disease associated with systemic inflammation, abnormal hemorheology, and coagulation dysfunction, all of which contribute to the development of atherosclerosis (AS). Inflammation and coagulation are closely intertwined processes; however, studies on the specific profiles of hemorheological and coagulation indices and their synergistic mechanisms remain limited.

OBJECTIVE

To compare differences in hemorheological and coagulation parameters and preliminarily elucidate the regulatory mechanism of the inflammation-hemorheology-coagulation axis.

METHODS

A total of 439 patients with psoriasis and 198 controls were enrolled; after PSM, 206 cases and 126 controls were included. All participants underwent vascular ultrasonography between May 2014 and February 2025. Patients were divided into the case group (psoriasis with AS) and control group (psoriasis without AS) based on vascular ultrasound and clinical assessment by specialized clinicians. PSM was used to balance baseline confounders, and sample sizes varied due to missing data. Statistical analyses included Spearman correlation and multivariate logistic regression.

RESULTS

The case group had higher fibrinogen (FIB) levels (3.54 vs. 3.11, P = 0.005, Cohen's d = 0.163) and shorter activated partial thromboplastin time (APTT) (26.40 vs. 27.60 s, P = 0.002, Cohen's d = 0.181). FIB showed the strongest association, with a correlation coefficient of 0.56 (P < 0.001) for systemic immune inflammation index (SII) and 0.39 (P < 0.001) for neutrophil-to-lymphocyte ratio (NLR) in the case group, and there was a strong positive correlation between SII and FIB (r = 0.56, P < 0.001). Psoriasis inflammation directly promoted vascular inflammation with a large effect size (β = 0.45, P < 0.001). Multivariate logistic regression analysis showed WBV (whole blood viscosity) (1 mPa·s) was the strongest predictor, with an OR of 1.752 (95% confidence interval [CI]: 1.314-2.651, P < 0.001).

LIMITATIONS: Selection and recall biases of retrospective single-center studies.

CONCLUSION

Patients with psoriasis, particularly those with severe disease, long disease duration, or complications from other thrombotic factors, should be closely monitored for hemorheological and coagulation parameters to prevent cardiovascular disease occurrence.