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

Suo, Huinan; Jiang, Bo; Sun, Xiaoyan; Dong, Jing; Alamgir, Mahin; Guan, Xin; Su, Hua; Liu, Yan; Yan, Xia; Zhou, Nan; Feng, Aiping; Tao, Juan

doi:10.1159/000520494

Cited by 5 publications

(5 citation statements)

References 25 publications

(34 reference statements)

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“…Other alternatives to SCORTEN have been proposed; the most popular being ABCD-10 which stands for age, bicarbonate, cancer, dialysis, 10% BSA. Studies comparing the accuracy of SCORTEN and ABCD-10 have largely found SCORTEN to be superior or equivalent to ABCD-10 ( 18 – 20 ). ABCD-10, like SCORTEN, also requires calculation of TBSAI.…”

Section: Discussionmentioning

confidence: 99%

“…A 2006 study found that delay-adjusted SCORTEN scores were comparable to crude scores but that there was significant difference in score between days 1 and 4 ( 19 ). Another study showed that SCORTEN and ABCD-10 performed differently depending on when after admission data were collected ( 20 ). Our model also does not take time point into account; however, we believe that the use of only lab values as continuous variables may allow for stability over time.…”

Section: Discussionmentioning

confidence: 99%

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An alternative model for assessing mortality risk in Stevens Johnson syndrome/toxic epidermal necrolysis using a random forests classifier: A pilot study

et al. 2022

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IntroductionMortality risk prediction is an important part of the clinical assessment in the Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) patient. The SCORTEN and ABCD-10 scoring systems have been used as predictive clinical tools for assessing this risk. However, some of the metrics required in calculating these scores, such as the total body surface area (TBSA) involvement, are difficult to calculate. In addition, TBSA involvement is calculated in a variety of ways and is observer dependent and subjective. The goal of this study was to develop an alternative method to predict mortality in patients with SJS/TEN.MethodsData was split into training and test datasets and preprocessed. Models were trained using five-fold cross validation. Out of several possible candidates, a random forests model was evaluated as being the most robust in predictive power for this dataset. Upon feature selection, a final random forests model was developed which was used for comparison against SCORTEN.ResultsThe differences in both accuracy (p = 0.324) and area under the receiver operating characteristic curve (AUROC) (p = 0.318) between the final random forests model and the SCORTEN and ABCD-10 models were not statistically significant. As such, this alternative method performs similarly to SCORTEN while only requiring simple laboratory tests from the day of admission.DiscussionThis new alternative can make the mortality prediction process more efficient, along with providing a seamless implementation of the patient laboratory tests directly into the model from existing electronic health record (EHR) systems. Once the model was developed, a web application was built to deploy the model which integrates with the Epic EHR system on the Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API); this only requires the patient medical record number and a date of the lab tests as parameters. This model ultimately allows clinicians to calculate patient mortality risk with only a few clicks. Further studies are needed for validation of this tool.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An alternative model for assessing mortality risk in Stevens Johnson syndrome/toxic epidermal necrolysis using a random forests classifier: A pilot study

et al. 2022

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“…While ABCD-10 has good discriminatory ability, multiple studies have showed that it underperforms in comparison to SCORTEN ( 3 , 7 , 15 , 16 ). Specifically, one retrospective cohort study in Singapore found that in both patients treated with supportive care or immunomodulatory therapy, ABCD-10 underestimated mortality at lower score ranges and overestimated mortality at higher score ranges ( 15 ).…”

Section: Strengths and Weaknesses Of Abcd-10mentioning

confidence: 99%

Scoring Assessments in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

et al. 2022

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Epidermal necrolysis, the unifying term for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is a severe cutaneous drug reaction associated with high morbidity and mortality. Given the rarity of this disease, large-scale prospective research studies are limited. Significant institutional and geographical variations in treatment practices highlight the need for standardization of clinical assessment scores and prioritization of research outcome measures in epidermal necrolysis. At the present, clinical assessment is typically simplified to total body surface area (BSA) involvement, with little focus on morphology. Validated clinical scoring systems are used as mortality prognostication tools, with SCORTEN being the best-validated tool thus far, although the ABCD-10 has also been recently introduced. These tools are imperfect in that they tend to either overestimate or underestimate mortality in certain populations and are not designed to monitor disease progression. Although mortality is often used as a primary endpoint for epidermal necrolysis studies, this outcome fails to capture more nuanced changes in skin disease such as arrest of disease progression while also lacking a validated skin-directed inclusion criterion to stratify patients based on the severity of skin disease at study entry. In addition to mortality, many studies also use BSA stabilization or time to re-epithelialization as endpoints, although these are not clearly defined morphologically, and inter- and intra-rater reliability are unclear. More specific, validated cutaneous assessment scores are necessary in order advance therapeutic options for epidermal necrolysis. In this review, we summarize the strengths and weaknesses of current clinical assessment practices in epidermal necrolysis and highlight the need for standardized research tools to monitor cutaneous involvement throughout the hospitalization.

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“…The SJS/TEN-specific severity-of-illness score (SCORTEN) has been the mainstay of measurements to define mortality risk of SJS/TEN in both clinical practice and research ( 44 ). The ABCD-10 (age, bicarbonate, cancer, dialysis, 10% BSA) is another cross-sectional severity scoring system that incorporated end-stage renal disease and was shown to perform slightly inferior to SCORTEN by underestimating mortality ( 45 , 46 ). Another study proposed adding inflammatory markers to the SCORTEN to improve predictive accuracy.…”

Section: Updates In Diagnosis Assessment and Causalitymentioning

confidence: 99%

Updates in SJS/TEN: collaboration, innovation, and community

Marks,

Botta,

Abe

et al. 2023

Front. Med.

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Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a predominantly drug-induced disease, with a mortality rate of 15–20%, that engages the expertise of multiple disciplines: dermatology, allergy, immunology, clinical pharmacology, burn surgery, ophthalmology, urogynecology, and psychiatry. SJS/TEN has an incidence of 1–5/million persons per year in the United States, with even higher rates globally. One of the challenges of SJS/TEN has been developing the research infrastructure and coordination to answer questions capable of transforming clinical care and leading to improved patient outcomes. SJS/TEN 2021, the third research meeting of its kind, was held as a virtual meeting on August 28–29, 2021. The meeting brought together 428 international scientists, in addition to a community of 140 SJS/TEN survivors and family members. The goal of the meeting was to brainstorm strategies to support the continued growth of an international SJS/TEN research network, bridging science and the community. The community workshop section of the meeting focused on eight primary themes: mental health, eye care, SJS/TEN in children, non-drug induced SJS/TEN, long-term health complications, new advances in mechanisms and basic science, managing long-term scarring, considerations for skin of color, and COVID-19 vaccines. The meeting featured several important updates and identified areas of unmet research and clinical need that will be highlighted in this white paper.

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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

Cited by 5 publications

References 25 publications

An alternative model for assessing mortality risk in Stevens Johnson syndrome/toxic epidermal necrolysis using a random forests classifier: A pilot study

An alternative model for assessing mortality risk in Stevens Johnson syndrome/toxic epidermal necrolysis using a random forests classifier: A pilot study

Scoring Assessments in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Updates in SJS/TEN: collaboration, innovation, and community

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