Poster Presentation Australasian Society for Dermatology Research 2022 Annual Scientific Meeting

Comparison of SCORTEN, ABCD10, auxiliary score in prognosis of retrospective cohort of SJS/TEN patients and development of new prognostic tool (#5)

Christopher Y Chew 1 2 3 4 , Adithya Shastry 1 5 , Dale Jobson 1 , Zhao Feng Liu 1 6 , Miki Wada 1 3 , Ella Ryan 1 6 , Zhengyang Liu 1 7 , Nidhin Kuruvilla 6 , Sarah Smithson 1 , Michelle Goh 1 , Douglas Gin 1
  1. Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
  2. Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
  3. Department of Dermatology, Monash Health, Melbourne, Victoria, Australia
  4. Department of Medicine, Monash University, Melbourne, Victoria, Australia
  5. ANU Medical School, Australian National University College of Health and Medicine, Canberra, ACT, Australia
  6. Monash Medical School, Monash University, Melbourne, Victoria, Australia
  7. Department of Dermatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Background:

Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) is a rare but severe cutaneous adverse reaction with significant morbiditiy and mortality. The SCORTEN, ABCD10 and auxiliary scores have been used in prognostication of SJS/TEN with variable degree of accuracy. We sought to assess the accuracy of these prognostic scores at risk stratification for patients diagnosed with SJS/TEN.

Method:

Patients managed at Alfred Hospital with SJS, TEN or SJS/TEN overlap syndrome between 1/7/13 to 30/6/21 were included. Area Under Receiver Operating Characteristic (AUROC) curve was used to compare the SCORTEN, ABCD10 and auxiliary scores in decreased and surviving patients. AUROC and single logistic regresion was used to assess the performance of a novel prognostic tool comprising 8 parameters.

Results:

A total of 83 patients were diagnosed with SJS, TEN or SJS/TEN. 90 day mortality was 18.1% (15/83). 90 day mortality AUROC [95% CI, p-value] was 0.8436 [0.7481-0.9392, p<0.0001], 0.8451 [0.7447-0.9455, p<0.0001] and 0.7956 [0.6729-0.9183, p=0.0004] for SCORTEN, ABCD10 and auxiliary scores respectively. Using 8 identified risk factors for mortality (age>50 and >70, albumin<20 and <25, bicarb<20, cr>100, ur>10, presence of malignancy, TBSA>10% and development of SJS/TEN as inpatient) AUROC was 0.8897 [0.8082-0.9713, p<0.0001].

 Conclusion:

SCORTEN and ABCD10 better predict mortality than the auxiliary score. In our cohort, this novel prognostic scoring method was more accurate at predicting 90 day mortality, however a larger and more diverse patient population will need to be assessed for validity.