Prediction Model Suggests Reduced Need for Laryngoscopy in Pemphigus Vulgaris

Key Takeaways

• Deep laryngeal involvement in pemphigus vulgaris occurred in nearly 20% of patients in this cohort.
• A 3-factor clinical model (hoarseness, dysphagia, PDAI score with sex interaction) demonstrated good discrimination (AUC 0.78).
• The model showed high negative predictive value (92.6%), supporting potential deferral of laryngoscopy in low-risk patients pending external validation.

A new proposed clinical prediction model may identify low-risk patients who can safely defer laryngoscopy, reducing unnecessary procedures.

Researchers for the retrospective cohort study from a tertiary dermatology center evaluated a clinical prediction model to identify deep laryngeal involvement in patients with pemphigus vulgaris (PV), a complication reported in up to 40% of cases and associated with airway risk. They analyzed 247 consecutively evaluated patients with confirmed PV between 2015 and 2022, all of whom underwent flexible fiber-optic laryngoscopy.

Deep laryngeal involvement was confirmed in 49 patients (19.8%). The authors identified 3 predictors: hoarseness (odds ratio [OR] = 2.50; 95% CI, 1.10 to 5.69), dysphagia (OR = 6.22; 95% CI, 2.78 to 13.92), and Pemphigus Disease Area Index (PDAI) score with a significant interaction by sex (P = 0.03).

The authors stratified patients with a simplified scoring system into low-risk (0-1 points; 0% observed involvement), intermediate-risk (2-3 points; 15.3%), and high-risk (≥4 points; 66.7%) groups. Model performance showed an AUC of 0.78 (95% CI, 0.71 to 0.84), with a negative predictive value of 92.6%.

Study limitations included its retrospective design, single-center setting, and lack of external validation, which may limit generalizability.

“In this study, the clinical prediction model using routinely assessed parameters achieved good discrimination and high negative predictive value,” the authors wrote. “If externally validated, this tool may help identify low-risk patients who can safely defer laryngoscopy while prioritizing higher-risk patients for evaluation.”