Virtual Poster Presentation Australasian Society for Dermatology Research 2022 Annual Scientific Meeting

Identification of novel prognostic markers for a contemporary cohort of SJS/TEN patients.  (#26)

Zhao Feng Liu 1 , Christopher Chew 1 2 , Dale Jobson 2 3 , Adithya Shastry 4 , Miki Wada 5 , Daniel Liu 6 , Ella Ryan 1 , Nidhin Kuruvilla 1 , Sarah Smithson 2 , Michelle Goh 2 , Douglas Gin 2
  1. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  2. Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
  3. School of Public Health and Preventative Medicine, Monash University, Melbourne , Victoria, Australia
  4. Department of Medicine , Australian National University, Canberra, ACT, Australia
  5. Monash Health, Melbourne , Victoria, Australia
  6. Royal Melbourne Hospital, Melbourne, Victoria, Australia

Background:

Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) are a spectrum of mucocutaneous adverse reactions associated with significant mortality. The SCORTEN tool, developed in 2000, is the most widely used prognostic indicator. Identification of novel markers may further improve risk stratification in a contemporary patient cohort.

 

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 standard continuous prognostic indicators of heart rate, urea and bicarbonate levels, as well as novel markers including creatinine, albumin and lymphocyte count between deceased and surviving patients.

 

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 0.5636 [0.3917-0.7354, p = 0.4559], 0.7828 [0.6648-0.9009, p=0.0006] and 0.6721 [0.4829-0.8613, p=0.0378] for heart rate, urea level and bicarbonate level respectively. Additionally, AUROC for initial albumin level was 0.7216 [0.5726-0.8705, p = 0.0075], trough albumin level 0.7358 [0.6204-0.8512, p=0.0044], initial creatinine level 0.7520 [0.6108-0.8931, p=0.0024] and peak lymphocyte count 0.7095 [0.5420-0.8769, p=0.0116] may represent novel prognostic markers for 90 day mortality.

 

Conclusion:

Initial urea and bicarbonate level but not heart rate are useful prognostic indicators of 90 day inpatient mortality. Initial albumin, trough albumin, initial creatinine and peak lymphocyte count may be considered additional prognostic indicators for patient with SJS, TEN or SJS/TEN overlap, including in assessment of trend and treatment efficacy.