Prognosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Cohort Study of 216 Patients in an Inpatient Dermatology Department

Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. However, only a few studies have investigated the clinicodemographic and laboratory parameters predicting SJS and TEN outcomes other than mortality, such as severe complications or increased length of hospital stays. Our objectives are to identify admission risk factors predictive of severe complications and the accompanying clinical or biochemical markers associated with prolonged hospitalization.

Methods: A retrospective cohort study over a 9-year period (2013-2022).

Results: The study included 216 patients with SJS (n = 122), SJS/TEN overlap (n = 71), and TEN (n = 23). On multivariate analysis, the clinical factor on admission that was predictive of severe complications was blood urea nitrogen (BUN) >8.3 mmol/L (p = 0.007). Furthermore, BSA epidermal detachment >10% (p < 0.001), Severity-of-illness score for TEN (SCORTEN-1) ≥2 (p = 0.04), and positive skin culture (p = 0.04), from which the Prolonged Hospitalization Risk Score was created, were predictive of length of hospital stays >10 days. Using systemic methylprednisolone at a mean dose ≥1 mg/kg/day for a median duration of 10.5 days was not shown to increase or reduce complication rates of SJS/TEN and shorten hospital stays.

Conclusion: BUN >8.3 mmol/L present at admission is a risk factor for severe complications of SJS/TEN. BSA involvement >10%, SCORTEN-1 ≥2, and positive skin culture on admission are useful markers to predict extended hospitalization.