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Risk Prediction of In-Hospital Mortality for SJS/TEN

JAMA Dermatol; ePub 2019 Mar 6; Noe, et al

In a recent cohort study of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), a 5-item mortality prediction model (ABCD-10; age, bicarbonate level, cancer, dialysis, and 10% involved body surface area [BSA]) accurately predicted in-hospital mortality, with discrimination that was not significantly different from Score of Toxic Epidermal Necrolysis (SCORTEN). Data from a multicenter cohort of patients aged ≥18 years treated for SJS/TEN were obtained from inpatient consult databases and electronic medical record systems at 18 medical centers in the US. Researchers found:

  • Among 370 patients (mean [SD] age 49.0 [19.1] years; 195 [52.7%] women), 54 (15.14%) did not survive to hospital discharge.
  • 5 covariates were independent predictors of in-hospital mortality: age in years, BSA in percentage of epidermal detachment, serum bicarbonate level <20 mmol/L, active cancer, and dialysis prior to admission.
  • The ABCD-10 model showed good discrimination (area under the curve [AUC], 0.816) and calibration.
  • For SCORTEN, the AUC was 0.827 and was not significantly different from that of the ABCD-10 model.

Noe MH, Rosenbach M, Hubbard RA, et al. Development and validation of a risk prediction model for in-hospital mortality among patients with Stevens-Johnson syndrome/toxic epidermal necrolysis—ABCD-10. [Published online ahead of print March 6, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.5605.