Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian Patients
Background: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatological emergencies. SCORTEN (SCORe of toxic epidermal necrolysis) is a validated score to predict mortality; however, there is a paucity of data to determine its usefulness in the Indian popu...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-01-01
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| Series: | Indian Journal of Dermatology |
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| Online Access: | https://journals.lww.com/10.4103/ijd.ijd_612_23 |
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| author | Neha Chetan Jangid Ankita Nirmal Choudhary Bela Jashwantlal Shah Shikha Rupalkumar Shah Harshita R Vyas Deval Mistry |
| author_facet | Neha Chetan Jangid Ankita Nirmal Choudhary Bela Jashwantlal Shah Shikha Rupalkumar Shah Harshita R Vyas Deval Mistry |
| author_sort | Neha Chetan Jangid |
| collection | DOAJ |
| description | Background:
Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatological emergencies. SCORTEN (SCORe of toxic epidermal necrolysis) is a validated score to predict mortality; however, there is a paucity of data to determine its usefulness in the Indian population.
Objective:
To evaluate the accuracy of SCORTEN as a prognostic marker in SJS-TEN.
Methods:
A prospective observational study was conducted at a tertiary care hospital for two years. SCORTEN was calculated on days one and three of admission. The actual death rates were compared to the predicted rates as estimated by the SCORTEN by standardised mortality ratio analysis (SMR).
Results:
Of 40 cases included in the study, the mean age was 36.2 ± 14 years (range 11–65) with the male: female ratio being 1.67:1. Antibiotics (37.5%) were the most common group followed by anticonvulsants (22.5%). Comorbidities were observed in 60% of cases, with epilepsy (17.5%) and HIV (human immunodeficiency virus) infection (12.5%) being common. On univariate analysis, heart rate > 120/min, epidermal detachment > 10% BSA, and Se HCO3 (bicarbonate) <20 mmol/L were associated significantly with the death of the subjects (P < 0.05). The observed mortalities were 4.34%, 0, 0 and 80% for SCORTEN 0–1 (3.2%), 2 (12.1%), 3 (35.8%) and 4 (58.3%) respectively when compared to expected mortality. SMR of SJS was 0.69 and of TEN was 1.49.
Conclusion:
SCORTEN gave an overestimation of mortality in patients with lower scores and an underestimation of mortality in patients with higher scores in our study. Minor refinements based on the study population may increase the predictive accuracy of the original scale. |
| format | Article |
| id | doaj-art-57153142aa9e4d78a7b78d8cffff2a7f |
| institution | Kabale University |
| issn | 0019-5154 1998-3611 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Dermatology |
| spelling | doaj-art-57153142aa9e4d78a7b78d8cffff2a7f2025-01-20T10:32:26ZengWolters Kluwer Medknow PublicationsIndian Journal of Dermatology0019-51541998-36112024-01-01691243110.4103/ijd.ijd_612_23Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian PatientsNeha Chetan JangidAnkita Nirmal ChoudharyBela Jashwantlal ShahShikha Rupalkumar ShahHarshita R VyasDeval MistryBackground: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatological emergencies. SCORTEN (SCORe of toxic epidermal necrolysis) is a validated score to predict mortality; however, there is a paucity of data to determine its usefulness in the Indian population. Objective: To evaluate the accuracy of SCORTEN as a prognostic marker in SJS-TEN. Methods: A prospective observational study was conducted at a tertiary care hospital for two years. SCORTEN was calculated on days one and three of admission. The actual death rates were compared to the predicted rates as estimated by the SCORTEN by standardised mortality ratio analysis (SMR). Results: Of 40 cases included in the study, the mean age was 36.2 ± 14 years (range 11–65) with the male: female ratio being 1.67:1. Antibiotics (37.5%) were the most common group followed by anticonvulsants (22.5%). Comorbidities were observed in 60% of cases, with epilepsy (17.5%) and HIV (human immunodeficiency virus) infection (12.5%) being common. On univariate analysis, heart rate > 120/min, epidermal detachment > 10% BSA, and Se HCO3 (bicarbonate) <20 mmol/L were associated significantly with the death of the subjects (P < 0.05). The observed mortalities were 4.34%, 0, 0 and 80% for SCORTEN 0–1 (3.2%), 2 (12.1%), 3 (35.8%) and 4 (58.3%) respectively when compared to expected mortality. SMR of SJS was 0.69 and of TEN was 1.49. Conclusion: SCORTEN gave an overestimation of mortality in patients with lower scores and an underestimation of mortality in patients with higher scores in our study. Minor refinements based on the study population may increase the predictive accuracy of the original scale.https://journals.lww.com/10.4103/ijd.ijd_612_23adverse drug reactionscyclosporineindian patientsscortenstevens-johnson syndrometoxic epidermal necrolysis |
| spellingShingle | Neha Chetan Jangid Ankita Nirmal Choudhary Bela Jashwantlal Shah Shikha Rupalkumar Shah Harshita R Vyas Deval Mistry Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian Patients Indian Journal of Dermatology adverse drug reactions cyclosporine indian patients scorten stevens-johnson syndrome toxic epidermal necrolysis |
| title | Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian Patients |
| title_full | Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian Patients |
| title_fullStr | Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian Patients |
| title_full_unstemmed | Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian Patients |
| title_short | Clinico- Therapeutic Study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis and Prognostic Significance of SCORTEN in Indian Patients |
| title_sort | clinico therapeutic study of stevens johnson syndrome toxic epidermal necrolysis and prognostic significance of scorten in indian patients |
| topic | adverse drug reactions cyclosporine indian patients scorten stevens-johnson syndrome toxic epidermal necrolysis |
| url | https://journals.lww.com/10.4103/ijd.ijd_612_23 |
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