Chiu Hsien-Yi, Chiu Ying-Ming
Department of Medical Research, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan.
Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
JAMA Dermatol. 2025 Apr 1;161(4):391-398. doi: 10.1001/jamadermatol.2024.5881.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) cause diffuse epidermal detachment and necrosis. Patients who survive the initial SJS/TEN episodes are affected by various sequelae.
To investigate the risks of cardiovascular morbidity and mortality in SJS/TEN survivors.
DESIGN, SETTING, AND PARTICIPANTS: This was a nationwide population-based cohort study using data from Taiwan's National Health Research Institute Database linked to the National Register of Death databases for 1998 to 2021. Survivors of SJS/TEN were identified and matched with non-SJS/TEN participants by age, sex, and Charlson Comorbidity Index. Data analysis was performed from November 2023 to June 2024.
Cerebrovascular accidents (CVA) or ischemic heart disease (IHD) after SJS/TEN survival.
Cox proportional hazards models were used to estimate the hazard ratios (HRs) of CVA and IHD morbidity and mortality after SJS/TEN survival.
The CVA cohort included 10 571 SJS/TEN survivors (mean [SD] age, 56.1 [18.5] years; 5358 females [50.7%] and 5213 males [49.3%]). The IHD cohort included 11 084 SJS/TEN survivors (mean [SD] age, 56.6 [18.6] years; 5561 females [50.2%] and 5523 males [49.8%]). The Cox proportional hazards model and competing risk regression model showed that compared with non-SJS/TEN participants, patients with SJS/TEN had higher risks of cardiovascular morbidity (CVA: HR, 1.65 [95% CI, 1.57-1.72] and subdistribution HR [sHR], 1.40 [95% CI, 1.33-1.46]; IHD: HR, 1.58 [95% CI, 1.51-1.65] and sHR, 1.32 [95% CI, 1.26-1.38]) and death due to cardiovascular disease (CVA: HR, 1.69; 95% CI, 1.46-1.96; IHD: HR, 1.55; 95% CI, 1.32-1.82). The increased cardiovascular mortality risks peaked at 1 year after SJS/TEN and persisted for 4 to 7 years. Older survivors and survivors admitted to an intensive care unit at SJS/TEN diagnosis had significantly higher cardiovascular mortality risk.
In this cohort study, SJS/TEN had a lasting association with cardiovascular function after the acute phase. This suggests a need to mitigate the elevated cardiovascular morbidity and mortality risks among survivors. Further research using databases or registries with more comprehensive clinical data are needed to validate these results.
史蒂文斯 - 约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）会导致弥漫性表皮剥脱和坏死。在SJS/TEN初始发作中存活下来的患者会受到各种后遗症的影响。
调查SJS/TEN幸存者发生心血管疾病的发病率和死亡率风险。
设计、设置和参与者：这是一项基于全国人口的队列研究，使用了台湾国立卫生研究院数据库与1998年至2021年国家死亡登记数据库的数据。通过年龄、性别和查尔森合并症指数确定SJS/TEN幸存者，并与非SJS/TEN参与者进行匹配。数据分析于2023年11月至2024年6月进行。
SJS/TEN存活后发生的脑血管意外（CVA）或缺血性心脏病（IHD）。
使用Cox比例风险模型估计SJS/TEN存活后CVA和IHD发病及死亡的风险比（HRs）。
CVA队列包括10571名SJS/TEN幸存者（平均[标准差]年龄，56.1[18.5]岁；5358名女性[50.7%]和5213名男性[49.3%]）。IHD队列包括11084名SJS/TEN幸存者（平均[标准差]年龄，56.6[18.6]岁；5561名女性[50.2%]和5523名男性[49.8%]）。Cox比例风险模型和竞争风险回归模型显示，与非SJS/TEN参与者相比，SJS/TEN患者发生心血管疾病的风险更高（CVA：HR，1.65[95%置信区间，1.57 - 1.72]和亚分布HR[sHR]，1.40[95%置信区间，1.33 - 1.46]；IHD：HR，1.58[95%置信区间, 1.51 - 1.65]和sHR，1.32[95%置信区间，1.26 - 1.38]）以及心血管疾病导致的死亡风险（CVA：HR，1.69；95%置信区间，1.46 - 1.96；IHD：HR，1.55；95%置信区间，1.32 - 1.82）。心血管死亡率增加的风险在SJS/TEN后1年达到峰值，并持续4至7年。年龄较大的幸存者以及在SJS/TEN诊断时入住重症监护病房的幸存者心血管死亡风险显著更高。
在这项队列研究中，SJS/TEN在急性期后与心血管功能存在持久关联。这表明有必要降低幸存者中心血管疾病发病率和死亡率升高的风险。需要使用具有更全面临床数据的数据库或登记处进行进一步研究以验证这些结果。
