Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China,
Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China,
Dermatology. 2022;238(4):736-744. doi: 10.1159/000520494. Epub 2021 Dec 7.
The newly described ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area [BSA]) is a 5-item mortality prediction model for patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). It was developed in the United States, has at present been externally tested only in the United States, Spain, and Singapore, and remains to be validated in resource-restricted settings. We sought to compare the accuracy of ABCD-10 and Score of Toxic Epidermal Necrolysis (SCORTEN) in predicting in-hospital mortality in a cohort from central China. Due to disease progression affecting the accuracy of the prediction model during hospitalization, for example, higher predictive accuracy of SCORTEN based on parameters collected on day 3 of hospitalization, we also assessed the overall predictive value of ABCD-10 on days 1 and 3, respectively.
A retrospective study was performed over a 10-year period (2010-2020) from 3 medical institutions in Wuhan. The performance of predictive models was assessed by both discrimination and calibration. Receiver-operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit tests and calibration plots were used to evaluate the model discrimination and calibration.
Of 84 included patients, 11 (13.1%) did not survive. The discrimination power of ABCD-10 was not significantly different from that of SCORTEN (area under the curve: day 1, p > 0.05; day 3, p > 0.05). Although the calibration of ABCD-10 was good, it was inferior to SCORTEN as it underestimated total mortality (Hosmer-Lemeshow goodness-of-fit test: day 1, p = 0.17 vs. p = 0.63; day 3, p = 0.35 vs. p = 0.93). Besides, the performance of ABCD-10 was slightly better on day 3 relative to day 1. During hospitalization, bacteremia developed in 21 (25.0%) patients, which was associated with a higher risk of death in our cohort (odds ratio, 22.88; 95% CI, 4.38-119.40; p < 0.001).
ABCD-10 showed acceptable overall performance, but revealed mortality underestimation and was inferior to the performance of SCORTEN. In consistence with SCORTEN, ABCD-10 was a better model when using values collected at day 3 of hospitalization relative to day 1.
新描述的 ABCD-10（年龄、碳酸氢盐、癌症、透析、10%体表面积[BSA]）是用于 Stevens-Johnson 综合征（SJS）/中毒性表皮坏死松解症（TEN）患者的死亡率预测模型。它是在美国开发的，目前仅在美国、西班牙和新加坡进行了外部测试，在资源有限的环境中仍有待验证。我们旨在比较 ABCD-10 和毒性表皮坏死松解症评分（SCORTEN）在预测中国中部队列住院死亡率方面的准确性。由于疾病进展会影响住院期间预测模型的准确性，例如，基于住院第 3 天收集的参数，SCORTEN 的预测准确性更高，我们还分别评估了 ABCD-10 在第 1 天和第 3 天的整体预测价值。
对来自武汉 3 家医疗机构的 10 年（2010-2020 年）回顾性研究进行了研究。通过区分度和校准来评估预测模型的性能。使用接收者操作特征（ROC）曲线、Hosmer-Lemeshow 拟合优度检验和校准图评估模型的区分度和校准。
84 例纳入患者中，11 例（13.1%）未存活。ABCD-10 的区分能力与 SCORTEN 无显著差异（曲线下面积：第 1 天，p＞0.05；第 3 天，p＞0.05）。尽管 ABCD-10 的校准良好，但它低估了总死亡率，不如 SCORTEN（Hosmer-Lemeshow 拟合优度检验：第 1 天，p=0.17 与 p=0.63；第 3 天，p=0.35 与 p=0.93）。此外，ABC-10 在第 3 天的表现略优于第 1 天。住院期间，21 例（25.0%）患者发生菌血症，这与我们队列中死亡风险增加相关（优势比，22.88；95%置信区间，4.38-119.40；p＜0.001）。
ABCD-10 表现出可接受的整体性能，但显示出死亡率低估，且性能不如 SCORTEN。与 SCORTEN 一致，当使用住院第 3 天收集的值时，ABCD-10 是一个更好的模型，而不是第 1 天。
