Disseminated intravascular coagulation in Stevens-Johnson syndrome and toxic epidermal necrolysis

Chen, Chun‐Bing; Hsu, Tsun-Hao; Hui, Rosaline Chung‐Yee; Lu, Chun‐Wei; Chen, Wei-Ti; Chiang, Pin-Hsuan; Wang, Chuang‐Wei; Chuang, Shiow-Shuh; Yang, Jui-Yung; Yang, Shih-Yi; Chang, Shu-Ying; Hsiao, Yen-Chang; Kao, Kuo‐Chin; Hu, Han‐Chung; Wu, Ting‐Shu; Hsu, Cheng–Lung; Hui‐Kang, David; Chen, Shin‐Yi; Tian, Ya-Chung; Cheng, Ching‐Yi; Chen, Chi‐Hua; Chi, Min‐Hui; Wu, Ming-Ying; Ren-feng, Liu; Wang, Chi-Hui; Chang, Ya‐Ching; Lin, Jingyi; Ho, Hung‐Yao; Yang, Lin; Chang, Chee Jen; Lin, Yu‐Jr; Ku, Cheng‐Lung; Hung, Shuen‐Iu; Chung, Wen‐Hung

doi:10.1016/j.jaad.2020.08.065

Cited by 17 publications

(10 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If there is any suspicion of infection, empiric antibiotic coverage for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa must be initiated until specific culture data from blood and urine cultures is obtained [ 4 ]. Also, while uncommon, signs of DIC must be monitored as it is associated with increased mortality [ 12 ]. SJS/TEN patients diagnosed with DIC had a greater than 10-fold increase in mortality compared to those not diagnosed with DIC (78.1% vs. 7%) [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Also, while uncommon, signs of DIC must be monitored as it is associated with increased mortality [ 12 ]. SJS/TEN patients diagnosed with DIC had a greater than 10-fold increase in mortality compared to those not diagnosed with DIC (78.1% vs. 7%) [ 12 ]. Unfortunately, our patient succumbed to both superinfection and DIC, which ultimately lead to his demise.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nivolumab-Induced Toxic Epidermal Necrolysis: Rare but Fatal Complication of Immune Checkpoint Inhibitor Therapy

Kim¹,

Khan

2021

Cureus

View full text Add to dashboard Cite

Toxic epidermal necrolysis (TEN) is a rare, but potentially fatal dermatological emergency most commonly caused by medication exposure. It is characterized by skin desquamation affecting over 30% of the body, and it remains a fatal condition with a high mortality rate. Nivolumab, an immune checkpoint inhibitor used in the treatment of various types of malignancies, has been linked to TEN. Nivolumab-induced TEN is a rare phenomenon with a low incidence rate in patients treated with a single-agent immune checkpoint inhibitor, but it has a high mortality rate that exceeds non-nivolumab-induced TEN. Nivolumab-induced TEN can present with many potential complications such as hemodynamic instability from excessive fluid loss, sepsis from bacterial superinfection, and disseminated intravascular coagulation. Due to its high mortality rate, prompt recognition of the condition, immediate withdrawal of the offending drug(s), vigorous skin care, multispecialty collaboration, and close monitoring of complications is needed. We present a case of nivolumab-induced TEN in an elderly male with a history of hepatocellular carcinoma who presented with acute-onset skin desquamation after nivolumab initiation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nivolumab-Induced Toxic Epidermal Necrolysis: Rare but Fatal Complication of Immune Checkpoint Inhibitor Therapy

Kim¹,

Khan

2021

Cureus

View full text Add to dashboard Cite

show abstract

“…DIC is not a rare but often unexamined complication in SJS/TEN patients. A recent study indicated that SJS/TEN patients with DIC were frequently associated with bacteremia and had a significantly higher risk of multiple organ failure and mortality [24]. Therefore, early identification, support, and treatment for these complications are important in reducing the mortality of SJS/ TEN.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Accuracy of ABCD-10 and SCORTEN in Predicting the In-Hospital Mortality of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multi-Institutional Study from Central China

et al. 2021

View full text Add to dashboard Cite

Background: The newly described ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area [BSA]) is a 5-item mortality prediction model for patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). It was developed in the United States, has at present been externally tested only in the United States, Spain, and Singapore, and remains to be validated in resource-restricted settings. We sought to compare the accuracy of ABCD-10 and Score of Toxic Epidermal Necrolysis (SCORTEN) in predicting in-hospital mortality in a cohort from central China. Due to disease progression affecting the accuracy of the prediction model during hospitalization, for example, higher predictive accuracy of SCORTEN based on parameters collected on day 3 of hospitalization, we also assessed the overall predictive value of ABCD-10 on days 1 and 3, respectively. Methods: A retrospective study was performed over a 10-year period (2010–2020) from 3 medical institutions in Wuhan. The performance of predictive models was assessed by both discrimination and calibration. Receiver-operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit tests and calibration plots were used to evaluate the model discrimination and calibration. Results: Of 84 included patients, 11 (13.1%) did not survive. The discrimination power of ABCD-10 was not significantly different from that of SCORTEN (area under the curve: day 1, p > 0.05; day 3, p > 0.05). Although the calibration of ABCD-10 was good, it was inferior to SCORTEN as it underestimated total mortality (Hosmer-Lemeshow goodness-of-fit test: day 1, p = 0.17 vs. p = 0.63; day 3, p = 0.35 vs. p = 0.93). Besides, the performance of ABCD-10 was slightly better on day 3 relative to day 1. During hospitalization, bacteremia developed in 21 (25.0%) patients, which was associated with a higher risk of death in our cohort (odds ratio, 22.88; 95% CI, 4.38–119.40; p < 0.001). Conclusion: ABCD-10 showed acceptable overall performance, but revealed mortality underestimation and was inferior to the performance of SCORTEN. In consistence with SCORTEN, ABCD-10 was a better model when using values collected at day 3 of hospitalization relative to day 1.

show abstract

“…There are some independent factors described in SCORTEN, or pre-existing renal failure and haemodialysis mentioned in ABCD-10 score known for their crucial impact on patients' survival in certain populations [11]. Several prognostic scores are used to predict mortality [12,13]. Acute Physiology and Chronic Health Evaluation (APACHE II) [14], Charlson Comorbidity Index (CCI) [15] or Sequential Organ Failure Assessment (SOFA) [16] [17].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of SCORTEN in predicting mortality

Strużyna

Surowiecka

Korzeniowski

et al. 2022

Preprint

View full text Add to dashboard Cite

BackgroundTEN patients require multi-directional and multi-disciplinary treatment. In most cases, they are hospitalised at intensive care units and require multi-directional, burn-complication preventive care. Choosing the most appropriate treatment option might be troublesome even when predicting scores are used. SCORTEN is the most renowned prognostic score for TEN patients, however, there are some data indicating that the accuracy of this test may be limited. The credibility of not just the predicted mortality risk, but also componential laboratory results and clinical features subject to debate. The aim of this study was to evaluate the efficacy and credibility of SCORTEN in clinical practice, on proprietary material. Methods: A retrospective analysis of 35 patients with diagnosed in histopathology TEN was performed. The inclusion criteria were as follows: day of submission before 5th day from the onset of the symptoms, full protocol of plasmaphereses and IVIGs according to our scheme.Results:The sensitivity of SCORTEN for the analysed cohort was 100%, with a specificity of 24%. The estimated death was 41,9%, while the actual death rates were 12,5%. Our protocol improved the survival, OR=26,57, RR=6,34, p=0,022. Decrease in mortality was caused by a combined treatment protocol we use- plasmaphereses with IVIGs. No independent risk factor was significant in death evaluation. Conclusions:Our data suggest that the scoring system for predicting death among TEN patients are reliable when they are high. New prognostic factors should be found to improve the evaluation of patients with low SCORTEN.

show abstract

Disseminated intravascular coagulation in Stevens-Johnson syndrome and toxic epidermal necrolysis

Cited by 17 publications

References 55 publications

Nivolumab-Induced Toxic Epidermal Necrolysis: Rare but Fatal Complication of Immune Checkpoint Inhibitor Therapy

Nivolumab-Induced Toxic Epidermal Necrolysis: Rare but Fatal Complication of Immune Checkpoint Inhibitor Therapy

Comparing the Accuracy of ABCD-10 and SCORTEN in Predicting the In-Hospital Mortality of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multi-Institutional Study from Central China

Accuracy of SCORTEN in predicting mortality

Contact Info

Product

Resources

About