論文

国際誌
2020年12月2日

Mortality and risk factors on admission in toxic epidermal necrolysis: A cohort study of 59 patients.

Allergology international : official journal of the Japanese Society of Allergology
  • Tomoya Watanabe
  • ,
  • Hirofumi Go
  • ,
  • Yusuke Saigusa
  • ,
  • Naoko Takamura
  • ,
  • Yuko Watanabe
  • ,
  • Yumiko Yamane
  • ,
  • Michiru Totsuka
  • ,
  • Hideyuki Ishikawa
  • ,
  • Kazuko Nakamura
  • ,
  • Setsuko Matsukura
  • ,
  • Takeshi Kambara
  • ,
  • Shunsuke Takaki
  • ,
  • Yukie Yamaguchi
  • ,
  • Michiko Aihara

記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1016/j.alit.2020.11.004

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening disorders characterized by widespread epidermal necrosis of the skin and mucosa. The severity-of-illness scoring system for TEN (SCORTEN) was widely used since 2000 as a standard prognostic tool consisting of seven clinical values. METHODS: To evaluate the prognosis using current treatments and risk factors for mortality, we retrospectively analyzed 59 cases of TEN, including SJS/TEN overlap treated in two university hospitals from January 2000 to March 2020. RESULTS: The mortality rate of TEN was 13.6% (8/59). All patients treated with high-dose steroid administration in combination with plasma exchange and/or immunoglobulin therapy recovered. Logistic regression analysis showed nine clinical composite scores, namely: heart rate (≧120 bpm), malignancy present, percentage of body surface area with epidermal detachment (>10%), blood urea nitrogen (>28 mg/dL), serum bicarbonate level (<20 mEq/L), serum glucose level (>252 mg/dL), age (≧71 years), the interval between disease onset and treatment initiation at the specialty hospital (≧8 days), and respiratory disorder within 48 h after admission. The receiver operating characteristic curves confirmed a high potential for predicting the prognosis of TEN. CONCLUSIONS: Recent developments in treatment strategies have contributed to the improved prognosis of TEN patients. A modified severity scoring model composed of nine scores may be helpful in the prediction of TEN prognosis in recent patients. Further large-scale studies are needed to confirm mortality findings to improve prognostication in patients with TEN.

リンク情報
DOI
https://doi.org/10.1016/j.alit.2020.11.004
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/33279401

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