Clinical and Biochemical Factors Associated With Hospitalization and Intensive Care Unit Admission Among Pregnant Women With Severe Psoriasis: A Retrospective Cohort Study

Abstract

Background and objective Severe psoriasis during pregnancy may be complicated by systemic inflammation, biochemical abnormalities, infection, and organ dysfunction requiring hospitalization or intensive care. Factors associated with escalation of care remain insufficiently characterized. The main objective of this study is to identify clinical and biochemical factors associated with hospitalization among pregnant women with severe psoriasis and explore factors associated with intensive care unit (ICU) admission. Methods This retrospective cohort study included 100 pregnant women with dermatologist-confirmed severe psoriasis treated at Continental Medical College, Lahore, Pakistan, from February to June 2026. Severe psoriasis was defined by Psoriasis Area and Severity Index ≥10, body surface area involvement ≥10%, generalized pustular psoriasis, or erythrodermic psoriasis. Clinical and biochemical findings recorded at presentation were compared between hospitalized and non-hospitalized participants. Multivariable logistic regression assessed factors independently associated with hospitalization. ICU analyses were exploratory because only 17 participants required intensive care. Results Fifty-eight participants were hospitalized, including 17 admitted to the ICU, while 42 were managed without admission. Generalized pustular or erythrodermic psoriasis (adjusted odds ratio (aOR), 4.16; 95% confidence interval (CI), 1.49-11.63), hypoalbuminemia (aOR, 3.42; 95% CI, 1.38-8.47), and elevated C-reactive protein (CRP) (aOR, 2.89; 95% CI, 1.21-6.91) were independently associated with hospitalization. Exploratory ICU analyses showed associations with systemic infection, acute kidney injury, hepatic dysfunction, and marked leukocytosis. Conclusion Severe systemic psoriasis phenotypes, elevated CRP, and hypoalbuminemia were independently associated with hospitalization. ICU findings were exploratory. These factors may support closer monitoring and multidisciplinary assessment but require external validation before use for clinical prediction or formal risk stratification.