Clinical value of the prognostic nutritional index and red blood cell distribution width‐to‐albumin ratio for the prediction of severity of and mortality associated with Stevens–Johnson syndrome/toxic epidermal necrolysis

Abstract

The prognostic nutritional index (PNI) and red blood cell distribution width-to-albumin ratio (RAR) are considered to be related to the prognosis of disease severity. However, the role of these biomarkers in predicting Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) severity and mortality is unclear. The aim of the current study was to investigate the association of PNI and RAR with severity and mortality in individuals with SJS/TEN. Clinical data were retrospectively collected from 74 individuals with SJS/ TEN and 74 healthy individuals, who were matched for age and sex during the same period. PNI, RAR, and other indicators were compared between individuals with SJS/ TEN and healthy controls. The association of PNI and RAR with SJS/TEN severity was assessed using Spearman or Pearson correlation analyses. Individuals with SJS/TEN were categorized into two groups, either survivors or nonsurvivors. The correlation between PNI, RAR, and SJS/TEN mortality was analyzed using univariate and multivariate logistic regression. The predictive value of the previously mentioned indicators on the mortality of patients with SJS/TEN was assessed using receiver operating characteristic curve analysis. The RAR level of patients with SJS/TEN was greater than that of the control group (p < 0.05), whereas PNI was lower. In compliance with correlation analysis, RAR was positively correlated with SCORTEN (Score of Toxic Epidermal Necrolysis) and ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area) (p < 0.05), and PNI was negatively correlated (p < 0.05). RAR is a risk factor for death in patients with SJS/TEN, but an elevated PNI level is a protective factor for mortality. The best cutoff values of PNI and RAR for predicting death in patients with SJS/TEN were 31.375 (sensitivity, 84.7%; specificity, 80%) and 0.486 (sensitivity, 73.3%; specificity, 84.7%). These results underscore the potential clinical value of PNI and RAR as appropriate and meaningful biomarkers to assess the severity of SJS/TEN and the mortality associated with it.

RDW-SD and PCT Are Potential Prognostic Factors for In-hospital Death in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

“… 15 Another study revealed that RDW/Alb could be a meaningful biomarker to assess the severity of SJS/TEN. 16 However, there have been no studies showing the role of RDW alone in the prognosis of SJS/TEN. In this study, RDW-SD47.9 fL and PCT > 0.67 ng/mL were screened out as significant risk factors for in-hospital death from the meaningful indicators of univariate analysis, which can partly corroborate these findings in the appeal.…”

“… 9 10 Other factors that may affect the prognosis of SJS/TEN include chronic kidney disease (CKD), 11 tuberculosis, 12 septicemia, 13 complications of respiratory disorder, 14 etc . In addition, the role of new inflammatory markers, such as red cell distribution width to hemoglobin ratio (RDW/Hb), 15 red blood cell distribution width to albumin ratio (RDW/Alb), 16 and neutrophil to lymphocyte ratio, 17 in the prognosis of SJS/TEN is also a research hotspot in recent years. However, due to the rarity of SJS/TEN and the heterogeneity of the studies, clinical risk factors for its mortality remain unclear.…”