Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea.
Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2739-2749.e3. doi: 10.1016/j.jaip.2019.05.047. Epub 2019 Jun 13.
Allopurinol is the most common cause of severe cutaneous adverse reactions (SCARs) in Korea due to the relatively high prevalence of the HLA-B*58:01 genotype (8%-13%).
We aimed to reveal the clinical characteristics and risk factors for death in allopurinol-induced SCARs in Korea.
We retrospectively reviewed the medical records of 106 subjects with allopurinol-induced SCARs and 639 subjects with other drug-induced SCARs who were enrolled in the Korean SCARs Registry (collected from 34 nationwide medical institutions) from January 2010 to December 2015.
Subjects with allopurinol-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) were older and had more comorbidities, longer latent periods, longer disease durations, more deranged laboratory findings, and increased disease severity resulting in a higher mortality rate (17.6% vs 7.6%; P = .020) compared with the subjects with other drug-induced SCARs. There was no significant difference in age or mortality in drug reaction with eosinophilia and systemic symptoms (DRESS). Subjects with allopurinol-induced SJS/TEN were older and had shorter latent periods and a higher mortality rate (17.6% vs 3.7%; P = .044) than those with allopurinol-induced DRESS. In allopurinol-induced SJS/TEN, significant risk factors for death included chronic renal insufficiency, intensive care unit (ICU) admission, increased blood urea nitrogen levels on admission day, serum peak eosinophil counts, baseline and peak creatinine levels, baseline and peak alanine aminotransferase levels, and decreased lowest platelet counts. In allopurinol-induced DRESS, significant risk factors for death included ICU admission and increased glucose levels on admission day.
Allopurinol-induced SCARs have unique characteristics and poor prognoses with important predictive factors of death.
由于 HLA-B*58:01 基因型（8%-13%）的相对高发率，别嘌醇是韩国导致严重皮肤不良反应（SCAR）的最常见原因。
本研究旨在揭示韩国别嘌醇诱导的 SCAR 患者死亡的临床特征和危险因素。
我们回顾性分析了 2010 年 1 月至 2015 年 12 月期间，来自韩国 34 家全国性医疗机构的韩国 SCAR 登记处（共纳入 106 例别嘌醇诱导的 SCAR 患者和 639 例其他药物诱导的 SCAR 患者）中 106 例别嘌醇诱导的 SCAR 患者和 639 例其他药物诱导的 SCAR 患者的病历。
与其他药物诱导的 SCAR 患者相比，别嘌醇诱导的史蒂文斯-约翰逊综合征（SJS）/中毒性表皮坏死松解症（TEN）患者年龄较大，合并症更多，潜伏期更长，疾病持续时间更长，实验室检查结果更紊乱，疾病严重程度更高，死亡率更高（17.6% vs 7.6%；P=0.020）。药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）患者的年龄或死亡率无显著差异。与别嘌醇诱导的 DRESS 相比，别嘌醇诱导的 SJS/TEN 患者年龄更大，潜伏期更短，死亡率更高（17.6% vs 3.7%；P=0.044）。在别嘌醇诱导的 SJS/TEN 中，死亡的显著危险因素包括慢性肾功能不全、入住重症监护病房（ICU）、入院当天血尿素氮水平升高、血清峰值嗜酸性粒细胞计数、基线和峰值肌酐水平、基线和峰值丙氨酸氨基转移酶水平以及最低血小板计数降低。在别嘌醇诱导的 DRESS 中，死亡的显著危险因素包括入住 ICU 和入院当天血糖升高。
别嘌醇诱导的 SCAR 具有独特的特征和不良预后，并有重要的死亡预测因素。
