Clinical Characteristics of Herpes Zoster Developing During Hospitalization Across Underlying Disease Groups: A Single-Center Retrospective Cohort Study

Background: Immunocompromised patients have a higher risk of developing herpes zoster. Evidence regarding the clinical characteristics and outcomes of herpes zoster developing during hospitalization, particularly across patients with malignancies and autoimmune diseases, remains limited. Methods: We conducted a single-center retrospective cohort study between 2015 to 2024. After screening medical records of inpatient cases in departments except dermatology, patients who developed herpes zoster during hospitalization were included. Based on the underlying diseases, patients were divided into immunocompromised groups of malignant solid tumor, hematologic malignancy, or autoimmune disease. We describe the clinical features of new-onset herpes zoster during hospitalization, and analyzed the differences among immunocompromised patients with different underlying diseases and immunocompetent patients. We also explored the factors associated with postherpetic neuralgia. Results: This study included 401 patients. After screening of immunocompromised status, 309 patients were included in four-group analysis. Patients with hematologic malignancies and autoimmune diseases were younger than immunocompetent patients. Multi-dermatomal or disseminated herpes zoster accounted for 19.4% cases in malignant solid tumor, 30.0% in hematologic malignancy, 24.6% in autoimmune disease, and 20.3% in immunocompetent groups, but the differences were not statistically significant. Immunocompromised groups tended to reported lower pain NRS scores. Crude prevalence of postherpetic neuralgia differed overall (P=0.014), while hematologic malignancy and immunocompetent groups did not differ in the adjusted pairwise comparison (29.8% vs 26.2%; adjusted P=0.649). In the complete-case multivariable model (n=320, 64 events of postherpetic neuralgia), higher pain NRS score (aOR=1.327 per point, 95% CI: 1.166– 1.511) and hematologic malignancy (aOR=3.000, 95% CI: 1.346– 6.687) were associated with postherpetic neuralgia. Conclusion: Multi-dermatomal or disseminated herpes zoster accounted for about one-fourth cases in our immunocompromised patients. Hematologic malignancy and greater pain severity were associated with postherpetic neuralgia in adjusted multivariate analyses. Our findings are exploratory and require external validation. Keywords: herpes zoster, inpatients, hematologic malignancy, postherpetic neuralgia, hospitalization