Bansal Shuchi, Garg Vijay K, Sardana Kabir, Sarkar Rashmi
Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Int J Dermatol. 2015 Jan;54(1):e18-26. doi: 10.1111/ijd.12466.
The SCORTEN scale (SCORe of Toxic Epidermal Necrolysis) is widely used to predict mortality in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Although it is largely a useful tool, the predictive ability of the scale is variable, and modifications to the existing scale have been suggested. In addition, there is controversy regarding the roles of active therapy and conservative management.
This study was conducted to assess outcomes in SJS/TEN patients managed conservatively and to analyze the predictive performance of SCORTEN.
Sixty patients were studied prospectively from October 2008 to September 2011. The accuracy of SCORTEN in predicting mortality was analyzed on days 1, 3, and 5 of admission. All patients were managed conservatively.
The discriminative power of SCORTEN was acceptable, being best on day 5. The agreement between actual and predicted mortality was poor, as indicated by a low P-value of the Hosmer-Lemeshow statistic. Only three parameters (heart rate, blood urea, and serum bicarbonate) were found to be significant on multivariate analysis, and all of these represented components within the original SCORTEN scale. The mortality rate was 16.7%. All deaths occurred within the first two weeks (8-12 days).
Serial analysis using SCORTEN is better than analysis performed only on day 1. Although the scale is largely useful, its performance is influenced by the demographic profile of the study population; minor modifications based on the population studied may increase the predictive accuracy of the original SCORTEN. In addition, conservative management is a valid therapeutic option, is preferable to treatment with steroids and immunosuppressants, and is highly recommended.
SCORTEN量表（中毒性表皮坏死松解症评分）被广泛用于预测史蒂文斯-约翰逊综合征（SJS）或中毒性表皮坏死松解症（TEN）患者的死亡率。尽管它在很大程度上是一个有用的工具，但该量表的预测能力存在差异，因此有人建议对现有量表进行修改。此外，对于积极治疗和保守管理的作用存在争议。
本研究旨在评估保守治疗的SJS/TEN患者的预后，并分析SCORTEN的预测性能。
对2008年10月至2011年9月期间的60例患者进行前瞻性研究。在入院第1、3和5天分析SCORTEN预测死亡率的准确性。所有患者均接受保守治疗。
SCORTEN的判别能力可以接受，在第5天最佳。实际死亡率与预测死亡率之间的一致性较差，Hosmer-Lemeshow统计量的P值较低表明了这一点。多变量分析发现只有三个参数（心率、血尿素和血清碳酸氢盐）具有显著性，所有这些都代表了原始SCORTEN量表中的组成部分。死亡率为16.7%。所有死亡均发生在头两周内（8 - 12天）。
使用SCORTEN进行系列分析优于仅在第1天进行的分析。尽管该量表在很大程度上有用，但其性能受研究人群的人口统计学特征影响；根据所研究的人群进行微小修改可能会提高原始SCORTEN的预测准确性。此外，保守管理是一种有效的治疗选择，优于使用类固醇和免疫抑制剂治疗，强烈推荐使用。
