Yii Matthew Min Xian, Rowson Antonia, van Ammers Milan, Prasad Jessica
Ear, Nose and Throat Department, Alfred Health, Melbourne, VIC 3004, Australia.
Eastern Health, Box Hill, VIC 3128, Australia.
Medicina (Kaunas). 2025 Mar 16;61(3):513. doi: 10.3390/medicina61030513.
: The primary objective of this study was to identify factors predictive of laryngeal involvement in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). The secondary objective was to observe the effect of laryngeal involvement upon short-term patient prognosis, including intensive care unit (ICU) stay and intubation rates. We present the largest cohort of patients examined for upper aerodigestive manifestations of SJS/TEN. : We performed a retrospective observational analytic study of patients at a state-wide Australian Burns referral center between January 2013 to December 2022. Inclusion criteria were adult patients who underwent flexible nasendoscopy (FNE) with biopsy-proven SJS/TEN. Data collected from medical records included patient factors, aerodigestive symptoms, bedside examination, FNE findings, TEN-specific severity-of-illness score (SCORTEN) on admission, and patient outcomes such as intubation and ICU admission. : Fifty-four patients with biopsy-proven SJS/TEN underwent FNE, with 17 (31.5%) identified to have laryngeal involvement. Laryngeal involvement was not significantly associated with intubation, ICU stay, or mortality ( > 0.05). The presence of either aerodigestive symptoms or oral cavity involvement was highly sensitive (94.1%, 95% CI 73.0-99.7%) for laryngeal involvement. : We did not find laryngeal involvement in SJS/TEN to significantly impact short-term outcomes, including intubation or mortality. FNE is the gold standard of upper aerodigestive assessment. Simple clinical evaluation of the oral cavity and a history of aerodigestive symptoms also provided a sensitive predictor of the laryngeal complications of SJS/TEN.
本研究的主要目的是确定史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症（SJS/TEN）患者喉部受累的预测因素。次要目的是观察喉部受累对患者短期预后的影响，包括重症监护病房（ICU）住院时间和插管率。我们呈现了检查SJS/TEN上呼吸道和消化道表现的最大患者队列。
我们对2013年1月至2022年12月期间澳大利亚一个州级烧伤转诊中心的患者进行了一项回顾性观察分析研究。纳入标准为接受过经活检证实为SJS/TEN的成人患者，并接受了可弯曲鼻内镜检查（FNE）。从病历中收集的数据包括患者因素、上呼吸道和消化道症状、床边检查、FNE结果、入院时的TEN特异性疾病严重程度评分（SCORTEN）以及患者结局，如插管和入住ICU情况。
54例经活检证实为SJS/TEN的患者接受了FNE检查，其中17例（31.5%）被确定有喉部受累。喉部受累与插管、ICU住院时间或死亡率无显著相关性（P>0.05）。上呼吸道和消化道症状或口腔受累的存在对喉部受累具有高度敏感性（94.1%，95%可信区间73.0 - 99.7%）。
我们发现SJS/TEN患者的喉部受累对包括插管或死亡率在内的短期结局没有显著影响。FNE是上呼吸道和消化道评估的金标准。对口腔进行简单的临床评估以及上呼吸道和消化道症状史也为SJS/TEN的喉部并发症提供了一个敏感的预测指标。
