红细胞分布宽度标准差（RDW-SD）和降钙素原（PCT）是史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症患者院内死亡的潜在预后因素。
RDW-SD and PCT Are Potential Prognostic Factors for In-hospital Death in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.
作者信息
Zhang Lixia, Lan Yunping, Qi Bo, Shuai Ping, Hou Qinchuan, Liu Wei, Wang Qian
机构信息
The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Intensive Care Unit, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Allergy Asthma Immunol Res. 2023 Nov;15(6):812-824. doi: 10.4168/aair.2023.15.6.812.
PURPOSE
Our study aimed to explore potential prognostic factors in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) patients from easily accessible laboratory data and to investigate whether the combination of these indicators with a score for toxic epidermal necrolysis (SCORTEN) can improve the predictive value.
METHODS
Data from 85 SJS/TEN patients hospitalized from 2010 to 2021 were retrospectively analyzed. The primary outcome was in-hospital mortality. Univariate analysis was used to screen for laboratory indexes associated with death. Logistic regression was used to analyze significant risk factors for death. The differentiation and calibration of SCORTEN and modified score were assessed using receiver operating characteristic (ROC) curves and Hosmer-Lemeshow goodness-of-fit test. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate the incremental prognostic value.
RESULTS
Among the 85 patients (37 males, 48 females) aged 14-88 years, the mortality rate was 11.8% (n = 10). SCORTEN had good discrimination and calibration to predict mortality in this cohort of patients (area under the ROC curve [AUC] of 0.874, 95% confidence interval [CI], 0.758-0.990; Hosmer-Lemeshow goodness-of-fit test = 0.994). Red cell distribution width-standard deviation index (RDW-SD) > 47.9 fL and procalcitonin (PCT) > 0.67 ng/mL were significant risk factors for death. When adding the 2 factors to SCORTEN, AUC was 0.915 (95% CI, 0.833-0.997), but not statistically different compared to SCORTEN alone ( = 0.091). The NRI was 1.2 (95% CI, 0.672-1.728; < 0.001) and the IDI was 0.09 (95% CI, 0.011-0.173; = 0.026), still suggesting that the modified score had better discriminatory and predictive power than SCORTEN alone. The modified score also showed good calibration (Hosmer-Lemeshow goodness-of-fit test, = 0.915).
CONCLUSIONS
SCORTEN is a good predictor of mortality in SJS/TEN patients in southwest China. Combining RDW-SD > 47.9 fL and PCT > 0.67 ng/mL with SCORTEN may enhance the ability to predict prognosis.
目的
我们的研究旨在从易于获取的实验室数据中探索史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症（SJS/TEN）患者的潜在预后因素，并研究这些指标与中毒性表皮坏死松解症评分（SCORTEN）相结合是否能提高预测价值。
方法
回顾性分析了2010年至2021年期间住院的85例SJS/TEN患者的数据。主要结局是院内死亡率。采用单因素分析筛选与死亡相关的实验室指标。使用逻辑回归分析死亡的显著危险因素。使用受试者工作特征（ROC）曲线和Hosmer-Lemeshow拟合优度检验评估SCORTEN和改良评分的区分度和校准度。使用净重新分类改善（NRI）和综合判别改善（IDI）评估增量预后价值。
结果
在这85例年龄在14至88岁之间的患者（37例男性，48例女性）中，死亡率为11.8%（n = 10）。SCORTEN在该队列患者中对死亡率具有良好的区分度和校准度（ROC曲线下面积[AUC]为0.874，95%置信区间[CI]为0.758 - 0.990；Hosmer-Lemeshow拟合优度检验 = 0.994）。红细胞分布宽度标准差指数（RDW-SD）> 47.9 fL和降钙素原（PCT）> 0.67 ng/mL是死亡的显著危险因素。将这两个因素添加到SCORTEN中时，AUC为0.915（95% CI为0.833 - 0.997），但与单独使用SCORTEN相比无统计学差异（ = 0.091）。NRI为1.2（95% CI为0.672 - 1.728； < 0.001），IDI为0.09（95% CI为0.011 - 0.173； = 0.026），仍表明改良评分比单独使用SCORTEN具有更好的区分度和预测能力。改良评分也显示出良好的校准度（Hosmer-Lemeshow拟合优度检验， = 0.915）。
结论
SCORTEN是中国西南部SJS/TEN患者死亡率的良好预测指标。将RDW-SD > 47.9 fL和PCT > 0.67 ng/mL与SCORTEN相结合可能会增强预后预测能力。
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