Oen I M M H, van der Vlies C H, Roeleveld Y W F, Dokter J, Hop M J, van Baar M E
Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands.
Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
J Eur Acad Dermatol Venereol. 2015 Dec;29(12):2444-50. doi: 10.1111/jdv.13352. Epub 2015 Sep 28.
Recently, the importance of reporting the results and principles of management in Toxic epidermal necrolysis (TEN) patients was underscored. Treatment of TEN focuses on supportive care, often provided in a burn centre setting. Mortality in TEN patients can be high; the SCORTEN score is a scoring system that predicts mortality in patients with TEN. The predictive value of the SCORTEN score in our setting is unclear, as are the treatment costs of TEN patients.
To describe patient characteristics, treatment, outcome and direct medical costs of patients with TEN treated in one Dutch burn centre in a 27-year period. In addition, determinants of mortality and the predictive value of the SCORTEN score were assessed.
A retrospective study was conducted in all patients with TEN (including Stevens-Johnson syndrome (SJS) and overlap SJS-TEN) admitted to the burn centre Rotterdam between January 1987 and December 2013. The discriminative value of the SCORTEN score was assessed by receiver-operator characteristics curve analysis.
A total of 63 patients were admitted in 27-year period. Overall mortality was 39.7%, mortality in TEN patients (>30%TBSA) was 37.1%. A higher age (OR = 1.04, 95%CI: 1.02-1.07) and comorbidity (OR = 4.25, 95%CI: 1.2-14.7) were associated with mortality. The discriminative value of the SCORTEN prediction model in our population was limited (AUC=0.72, 95%CI: 0.57-0.86). The mean direct medical hospital-based costs was €41.361.
Toxic epidermal necrolysis is a severe adverse drug reaction, with a high mortality. Elderly patients and patients with comorbidity, especially circulatory comorbidity, have a relatively high risk of decease. The SCORTEN score, a frequently used prediction model in patients with TEN, underestimated the mortality in our study, mainly due to limited availability in patients with a good prognosis. The treatment of patient with TEN is associated with high direct medical hospital-based costs, also compared to burn patients in general.
最近，强调了报告中毒性表皮坏死松解症（TEN）患者的治疗结果和原则的重要性。TEN的治疗重点是支持性护理，通常在烧伤中心进行。TEN患者的死亡率可能很高；SCORTEN评分是一种预测TEN患者死亡率的评分系统。在我们的研究环境中，SCORTEN评分的预测价值尚不清楚，TEN患者的治疗成本也是如此。
描述在一家荷兰烧伤中心27年间治疗的TEN患者的特征、治疗、结局和直接医疗费用。此外，评估死亡率的决定因素和SCORTEN评分的预测价值。
对1987年1月至2013年12月期间入住鹿特丹烧伤中心的所有TEN患者（包括史蒂文斯-约翰逊综合征（SJS）和重叠型SJS-TEN）进行回顾性研究。通过受试者工作特征曲线分析评估SCORTEN评分的判别价值。
27年间共收治63例患者。总体死亡率为39.7%，TEN患者（>30%体表面积）的死亡率为37.1%。较高的年龄（OR = 1.04，95%CI：1.02-1.07）和合并症（OR = 4.25，95%CI：1.2-14.7）与死亡率相关。SCORTEN预测模型在我们人群中的判别价值有限（AUC = 0.72，95%CI：0.57-0.86）。基于医院的平均直接医疗费用为41361欧元。
中毒性表皮坏死松解症是一种严重的药物不良反应，死亡率很高。老年患者和合并症患者，尤其是循环系统合并症患者，死亡风险相对较高。SCORTEN评分是TEN患者常用的预测模型，在我们的研究中低估了死亡率，主要原因是预后良好的患者中该评分的可用性有限。与一般烧伤患者相比，TEN患者的治疗也与较高的基于医院的直接医疗费用相关。
