Clinical and anamnestic analysis of patients diagnosed with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis who received inpatient treatment in medical institutions of Moscow. Development of a prognostic model of unfavorable outcome development.

Abstract

BACKGROUND: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe life-threatening disorders with massive lesions of the skin and mucosa. At present, considering the high mortality rate, one of the most promising areas of research is the study of predictors of the severity, since prognosis of the course of the disease can further influence the choice of treatment strategy.

AIMS: Determination of epidemiological features, identification of clinical and laboratory predictors of severe course, and construction of a prognostic model for patients with Stevens-Johnson syndrome and toxic epidermal necrolysis within the framework of analysis of electronic medical records of Moscow.

MATERIALS AND METHODS: The study was based on a retrospective analysis of medical records of patients with SJS/TEN from 2020 to 2023. Initially, 230 individuals over 18 years of age were included in the analysis.  As a result of selection from the primary cohort, 122 patients fulfilling the criteria for the diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis were included in the final analysis. Patients did not undergo additional follow-up as part of this study. 

RESULTS: In the analyzed cohort, there was a prevalence of female patients (n=72; 59.01%) over male patients (n=50; 40.99%).  Lethal outcome was recorded in 27 patients (22.13%), of which 21 (77.8%) had a verified diagnosis of toxic epidermal necrolysis, which was associated with a higher incidence of death compared to SJS (n=6 (p=0.001)). It was found that 112 (91.8%) cases were more likely to be associated with medication use, while 10 (8.2%) had a significantly confirmed infectious agent Mycoplasma pneumoniae. Antiepileptic drugs were the most frequent drug-induced SJS/TEN (n = 62; 55.4%). Based on the analysed clinical and laboratory data, a prognostic model was developed to determine the probability of lethal outcome, including decreased serum bicarbonate, increased levels of c-reactive protein, fibrinogen, fever, hypoalbuminemia.

CONCLUSIONS: Stevens-Johnson syndrome and toxic epidermal necrolysis are rare conditions with a high mortality rate and high risk of disabling complications. Early verification of the diagnosis and stratification of patients by severity group is optimal for the choice of treatment tactics; however, further work is currently needed to standardise the assessment of the severity of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.