Luong Nguyen Dac Thuy, Duc Hoang Vuong Ngoc, Vu Thi Thuy Trang, Tran Khiem Hung, Pham Van Bac
University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam,
Ho Chi Minh City Hospital of Dermato-Venerology, Ho Chi Minh City, Vietnam.
Dermatology. 2025;241(1):49-58. doi: 10.1159/000542623. Epub 2024 Nov 27.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. However, only a few studies have investigated the clinicodemographic and laboratory parameters predicting SJS and TEN outcomes other than mortality, such as severe complications or increased length of hospital stays. Our objectives are to identify admission risk factors predictive of severe complications and the accompanying clinical or biochemical markers associated with prolonged hospitalization.
A retrospective cohort study over a 9-year period (2013-2022).
The study included 216 patients with SJS (n = 122), SJS/TEN overlap (n = 71), and TEN (n = 23). On multivariate analysis, the clinical factor on admission that was predictive of severe complications was blood urea nitrogen (BUN) >8.3 mmol/L (p = 0.007). Furthermore, BSA epidermal detachment >10% (p < 0.001), Severity-of-illness score for TEN (SCORTEN-1) ≥2 (p = 0.04), and positive skin culture (p = 0.04), from which the Prolonged Hospitalization Risk Score was created, were predictive of length of hospital stays >10 days. Using systemic methylprednisolone at a mean dose ≥1 mg/kg/day for a median duration of 10.5 days was not shown to increase or reduce complication rates of SJS/TEN and shorten hospital stays.
BUN >8.3 mmol/L present at admission is a risk factor for severe complications of SJS/TEN. BSA involvement >10%, SCORTEN-1 ≥2, and positive skin culture on admission are useful markers to predict extended hospitalization.
史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是严重的皮肤不良反应。然而，仅有少数研究调查了除死亡率之外预测SJS和TEN结局的临床人口统计学和实验室参数，如严重并发症或住院时间延长。我们的目标是确定预测严重并发症的入院风险因素以及与延长住院时间相关的伴随临床或生化标志物。
一项为期9年（2013 - 2022年）的回顾性队列研究。
该研究纳入了216例SJS患者（n = 122）、SJS/TEN重叠综合征患者（n = 71）和TEN患者（n = 23）。多因素分析显示，入院时预测严重并发症的临床因素是血尿素氮（BUN）>8.3 mmol/L（p = 0.007）。此外，体表面积（BSA）表皮剥脱>10%（p < 0.001）、TEN疾病严重程度评分（SCORTEN-1）≥2（p = 0.04）和皮肤培养阳性（p = 0.04），据此创建的延长住院风险评分可预测住院时间>10天。平均剂量≥1 mg/kg/天的全身性甲泼尼龙使用中位持续时间为10.5天，未显示会增加或降低SJS/TEN的并发症发生率，也未缩短住院时间。
入院时BUN>8.3 mmol/L是SJS/TEN严重并发症的风险因素。入院时BSA累及>10%、SCORTEN-1≥2和皮肤培养阳性是预测延长住院时间的有用标志物。
