Stewart Thomas Jonathan, Shah Hemali, Frew John
Department of Dermatology, Addenbrookes Hospital, Cambridge, UK.
School of Medicine, University of New South Wales, Kensington, NSW, Australia.
Int J Dermatol. 2025 May;64(5):849-860. doi: 10.1111/ijd.17529. Epub 2024 Oct 24.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe cutaneous adverse reactions that result in in-hospital death in 12-49% of cases. The severity-of-illness score for toxic epidermal necrolysis (SCORTEN) is the most widely used mortality prognosis score; however, it has been shown to have critical limitations. Other mortality predictors not incorporated in SCORTEN or other predictor tools are being increasingly reported. This systematic review and meta-analysis aimed to synthesize and evaluate the predictors of mortality in adults with Stevens-Johnson syndrome and toxic epidermal necrolysis not included in SCORTEN. It was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Potential bias was assessed using the National Institutes of Health (NIH) criteria. Forty articles describing results from 52,398 cases were included. Sixteen predictors were reported in five or more articles, and thirty-three were reported in two to four articles. Meta-analysis showed preexisting renal disease (odds ratio (OR): 3.14, 95% confidence interval (CI): 1.99-4.97, P < 0.0001, I = 21%), renal involvement (OR: 5.62, 95% CI: 2.29-13.77, P = 0.0002, I = 36%), respiratory involvement (OR: 3.14, 95% CI: 1.25-7.92, P = 0.015, I = 66%), diabetes mellitus (OR: 1.87, 95% CI: 1.21-2.89, P = 0.005, I = 19%), sepsis (OR: 5.64, 95% CI: 2.81-11.29, P < 0.0001, I = 63%), comorbidity (OR: 9.13, 95% CI: 4.60-18.12, P < 0.0001, I = 0%), and time to hospitalization (OR: 2.56, 95% CI: 1.15-5.65, P = 0.021, I = 93) increased risk of mortality. This systematic review and meta-analysis support several clinical and laboratory parameters not included in SCORTEN (preexisting renal disease, renal involvement, respiratory involvement, diabetes mellitus, sepsis, comorbidities, and time to hospitalization) as predictors of mortality in adults with SJS/TEN. The future utilization of these factors may improve mortality prognostication in adults with SJS/TEN.
史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是罕见的严重皮肤不良反应，12%至49%的病例会在住院期间死亡。中毒性表皮坏死松解症严重程度评分（SCORTEN）是使用最广泛的死亡率预后评分；然而，它已被证明存在严重局限性。越来越多的报告指出了其他未纳入SCORTEN或其他预测工具的死亡率预测因素。本系统评价和荟萃分析旨在综合和评估未纳入SCORTEN的成人史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症死亡率的预测因素。它已在国际注册系统评价和荟萃分析方案平台（INPLASY）注册，并按照系统评价和荟萃分析的首选报告项目（PRISMA）报告指南进行。使用美国国立卫生研究院（NIH）标准评估潜在偏倚。纳入了40篇描述52398例病例结果的文章。16个预测因素在五篇或更多文章中被报道，33个在两篇至四篇文章中被报道。荟萃分析显示，既往肾脏疾病（比值比（OR）：3.14，95%置信区间（CI）：1.99 - 4.97，P < 0.0001，I = 21%）、肾脏受累（OR：5.62，95% CI：2.29 - 13.77，P = 0.0002，I = 36%）、呼吸受累（OR：3.14，95% CI：1.25 - 7.92，P = 0.015，I = 66%）、糖尿病（OR：1.87，95% CI：1.21 - 2.89，P = 0.005，I = 19%）、脓毒症（OR：5.64，95% CI：2.81 - 11.29，P < 0.0001，I = 63%）、合并症（OR：9.13，95% CI：4.60 - 18.12，P < 0.0001，I = 0%）以及住院时间（OR：2.56，95% CI：1.15 - 5.65，P = 0.021，I = 93）会增加死亡风险。本系统评价和荟萃分析支持了一些未纳入SCORTEN的临床和实验室参数（既往肾脏疾病、肾脏受累、呼吸受累、糖尿病、脓毒症、合并症以及住院时间）可作为成人SJS/TEN死亡率的预测因素。未来利用这些因素可能会改善成人SJS/TEN的死亡率预后。
