Accuracy of SCORTEN and ABCD-10 to predict mortality and the influence of renal function in Stevens–Johnson syndrome/toxic epidermal necrolysis

Autores de IIS La Fe

• Ignacio Torres Navarro

  Autor

• Antonio Javier Sahuquillo Torralba

  Autor

• Anaid Calle Andrino

  Autor

• Blanca De Unamuno Bustos

  Autor

• Jennifer Piqueras García

  Autor

• 

  Rafael Botella Estrada

  Autor

Participantes ajenos a IIS La Fe

• Briz-Redón Á.
• Botella-Casas G.
• Roca Ginés J.
• Magdaleno Tapial J.
• Alegre de Miquel V.

Grupos

• Dermatología y Regeneración Tisular

Abstract

Epidermal necrolysis (EN) compromises a spectrum of life-threatening dermatoses (Stevens–Johnson Syndrome [SJS], overlap syndrome and toxic epidermal necrolysis [TEN]). Currently, no active therapeutic regimen with unequivocal benefit exists for SJS/TEN. SCORTEN is the widely-used prognostic scale specific for SJS/TEN. Nevertheless, a new prognostic scale, the ABCD-10, has been recently proposed. In this context, acute renal failure (ARF) seems to be an important comorbidity that could influence prognosis in SJS/TEN patients more than it is assumed by these two scales. Our objectives were to compare the accuracy of the SCORTEN and ABCD-10 scales in predicting the mortality in SJS/TEN, and to investigate the influence of renal failure on prognosis. The prognostic results of 18 patients with EN treated in two referral centers between 2013 and 2018 are presented. SCORTEN, ABCD-10 and renal function values were retrospectively collected for all patients. Out of the 18 patients who were analyzed, nine (50%) received only supportive therapy, four were treated with etanercept 50 mg in a single dose (22.2%) and five with corticosteroids (27.8%). Five patients developed ARF. Predicted mortality was 3.48 for SCORTEN and 2.33 for ABCD-10. Eventually, four patients died (22.2%), all had ARF and none of them received active treatment. Despite study limitations and in the absence of active treatment of choice, SCORTEN behaved as a reliable predictor of mortality in patients with EN, outperforming the newer ABCD-10. ARF was an early event associated with a poor prognosis, which could represent a prognostic marker to consider in the future. © 2020 Japanese Dermatological Association

Keywords

• Adrenal Cortex Hormones; Comorbidity; Humans; Prognosis; Retrospective Studies; Stevens-Johnson Syndrome; corticosteroid; etanercept; corticosteroid; ABCD 10 score; acute kidney failure; adult; aged; Article; clinical article; comparative effectiveness; diagnostic accuracy; female; human; kidney failure; male; middle aged; mortality; prognosis; SCORTEN score; single drug dose; Stevens Johnson syndrome; toxic epidermal necrolysis; urogenital tract disease assessment; very elderly; comorbidity; retrospective study; Stevens Johnson syndrome