Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center Experience
<i>Background and Objectives</i>: Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare yet life-threatening dermatologic conditions characterized by severe skin and mucous membrane involvement. Accurate prognostic systems are crucial for clinical management to ass...
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2025-01-01
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| author | David Breidung Sarina Delavari Ioannis-Fivos Megas Alexander Geierlehner Wolfgang Hitzl Karl J. Bodenschatz Konrad Karcz Denis Ehrl Moritz Billner |
| author_facet | David Breidung Sarina Delavari Ioannis-Fivos Megas Alexander Geierlehner Wolfgang Hitzl Karl J. Bodenschatz Konrad Karcz Denis Ehrl Moritz Billner |
| author_sort | David Breidung |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare yet life-threatening dermatologic conditions characterized by severe skin and mucous membrane involvement. Accurate prognostic systems are crucial for clinical management to assess disease severity and predict outcomes. The primary objective of this study was to assess the epidemiological characteristics and clinical outcomes of patients with Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap over a 17-year period at a specialized burn center. The secondary objectives were to evaluate the performance of existing prognostic scoring systems (SCORTEN, Re-SCORTEN, and ABCD-10) in predicting mortality and to propose a novel classification tree model to improve mortality prediction. <i>Materials and Methods</i>: A 17-year retrospective study at a burn center included 68 patients with SJS, SJS/TEN overlap, or TEN. Demographic, clinical, laboratory data, and prognostic scores (SCORTEN, Re-SCORTEN, ABCD-10) were collected and analyzed for associations with mortality. A classification tree was created to detect unknown determinants of SJS/TEN mortality. <i>Results</i>: The drug most frequently associated with the occurrence of SJS/TEN was metamizole. The mortality rate was 51%. Affected body surface area, platelet count, and serum blood urea nitrogen differed significantly between survivors and non-survivors. Regarding the scoring systems, only the Re-SCORTEN showed reliable differentiation for these groups. A classification tree model achieved an accuracy of 89% in predicting the mortality risk. In the ROC curve analysis, the AUC values were 0.88 for the classification tree, 0.66 for Re-SCORTEN, 0.61 for SCORTEN, and 0.56 for ABCD-10. <i>Conclusions</i>: This study explores mortality predictors in SJS/TEN via a classification tree model, highlighting potential factors for further investigation. While cautioning against immediate clinical application due to data constraints, the findings underscore the need for larger studies to validate and refine prediction models in this context. |
| format | Article |
| id | doaj-art-f0a2d234124d442bb23a79609f8cea22 |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-01-01 |
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| series | Medicina |
| spelling | doaj-art-f0a2d234124d442bb23a79609f8cea222025-01-24T13:40:27ZengMDPI AGMedicina1010-660X1648-91442025-01-016116610.3390/medicina61010066Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center ExperienceDavid Breidung0Sarina Delavari1Ioannis-Fivos Megas2Alexander Geierlehner3Wolfgang Hitzl4Karl J. Bodenschatz5Konrad Karcz6Denis Ehrl7Moritz Billner8Department of Plastic, Reconstructive and Hand Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, GermanyDepartment of Plastic, Reconstructive and Hand Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, GermanyDepartment of Plastic, Reconstructive and Hand Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, GermanyDepartment of Plastic, Reconstructive and Hand Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, GermanyResearch and Innovation Management (RIM), Paracelsus Medical University Salzburg, 5020 Salzburg, AustriaDepartment for Pediatric Surgery, Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, Prof.-Ernst-Nathan Straße 1, 90419 Nuremberg, GermanyDepartment of Plastic, Reconstructive and Hand Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, GermanyDepartment of Plastic, Reconstructive and Hand Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, GermanyDepartment of Plastic, Reconstructive and Hand Surgery, Burn Unit, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, Germany<i>Background and Objectives</i>: Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare yet life-threatening dermatologic conditions characterized by severe skin and mucous membrane involvement. Accurate prognostic systems are crucial for clinical management to assess disease severity and predict outcomes. The primary objective of this study was to assess the epidemiological characteristics and clinical outcomes of patients with Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap over a 17-year period at a specialized burn center. The secondary objectives were to evaluate the performance of existing prognostic scoring systems (SCORTEN, Re-SCORTEN, and ABCD-10) in predicting mortality and to propose a novel classification tree model to improve mortality prediction. <i>Materials and Methods</i>: A 17-year retrospective study at a burn center included 68 patients with SJS, SJS/TEN overlap, or TEN. Demographic, clinical, laboratory data, and prognostic scores (SCORTEN, Re-SCORTEN, ABCD-10) were collected and analyzed for associations with mortality. A classification tree was created to detect unknown determinants of SJS/TEN mortality. <i>Results</i>: The drug most frequently associated with the occurrence of SJS/TEN was metamizole. The mortality rate was 51%. Affected body surface area, platelet count, and serum blood urea nitrogen differed significantly between survivors and non-survivors. Regarding the scoring systems, only the Re-SCORTEN showed reliable differentiation for these groups. A classification tree model achieved an accuracy of 89% in predicting the mortality risk. In the ROC curve analysis, the AUC values were 0.88 for the classification tree, 0.66 for Re-SCORTEN, 0.61 for SCORTEN, and 0.56 for ABCD-10. <i>Conclusions</i>: This study explores mortality predictors in SJS/TEN via a classification tree model, highlighting potential factors for further investigation. While cautioning against immediate clinical application due to data constraints, the findings underscore the need for larger studies to validate and refine prediction models in this context.https://www.mdpi.com/1648-9144/61/1/66toxic epidermal necrolysisStevens–Johnson syndromedrug reactionSCORTENABCD-10 |
| spellingShingle | David Breidung Sarina Delavari Ioannis-Fivos Megas Alexander Geierlehner Wolfgang Hitzl Karl J. Bodenschatz Konrad Karcz Denis Ehrl Moritz Billner Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center Experience Medicina toxic epidermal necrolysis Stevens–Johnson syndrome drug reaction SCORTEN ABCD-10 |
| title | Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center Experience |
| title_full | Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center Experience |
| title_fullStr | Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center Experience |
| title_full_unstemmed | Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center Experience |
| title_short | Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome: Insights from a 17-Year Burn Center Experience |
| title_sort | epidemiological characteristics and prognostic scoring in toxic epidermal necrolysis and stevens johnson syndrome insights from a 17 year burn center experience |
| topic | toxic epidermal necrolysis Stevens–Johnson syndrome drug reaction SCORTEN ABCD-10 |
| url | https://www.mdpi.com/1648-9144/61/1/66 |
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