SCORTEN: A Severity-of-Illness Score for Toxic Epidermal Necrolysis

Abstract

The mortality of toxic epidermal necrolysis is about 30%. Our purpose was to develop and validate a specific severity-of-illness score for cases of toxic epidermal necrolysis admitted to a specialized unit and to compare it with the Simplified Acute Physiology Score and a burn scoring system. A sample of 165 patients was used to develop the toxic epidermal necrolysis-specific severity-of-illness score and evaluate the other scores, a sample of 75 for validation. Model development used logistic regression equations that were translated into probability of hospital mortality; validation used measures of calibration and discrimination. We identified seven independent risk factors for death and constituted the toxic epidermal necrolysis-specific severity-of-illness score: age above 40 y, malignancy, tachycardia above 120 per min, initial percentage of epidermal detachment above 10%, serum urea above 10 mmol per liter, serum glucose above 14 mmol per liter, and bicarbonate below 20 mmol per liter. For each toxic epidermal necrolysis-specific severity-of-illness score point the odds ratio was 3.45 (confidence interval 2.26-5.25). Probability of death was: P(death) = elogit/1 + elogit with logit = -4.448 + 1.237 (toxic epidermal nec-rolysis-specific severity-of-illness score). Calibration demonstrated excellent agreement between expected (19. 6%) and actual (20%) mortality; discrimination was also excellent with a receiver operating characteristic area of 82%. The Simplified Acute Physiology Score and the burn score were also associated with mortality. The discriminatory powers were poorer (receiver operating characteristic area: 72 and 75%) and calibration of the Simplified Acute Physiology Score indicated a poor agreement between expected (9.1%) and actual (26.7%) mortality. This study demonstrates that the risk of death of toxic epidermal necrolysis patients can be accurately predicted by the toxic epidermal necrolysis-specific severity-of-illness score. The Simplified Acute Physiology Score and burn score appear to be less adequate.

Severe Drug Eruption in Guinea Conakry

“…These data, although they are limited by methodological bias, suggest that opportunistic infections induced by immunosuppression due to HIV are a poor prognostic factor in the TEN. A French study has identified seven prognostic factors in the SJS/TEN, originally a severity score, the SCORTEN, which predicts the evolution of TEN [19] [20]. There was not HIV-related immunosuppression among these prognostic factors.…”

Acute Renal Failure and Its Risk Factors in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

“…EMM patients were classified as the EMM group and all the other patients were classified as the SJS/TEN group [5, 8, 10]. …”

“…Also the renal manifestation in SJS/TEN is largely unknown. Drug, insensible water loss, sepsis and diarrhea might further complicate renal injury [8, 9]. In view of the above, we carried out a retrospective study to investigate renal manifestations and risk factors of acute renal failure (ARF) in SJS/TEN and to determine whether skin detachment in SJS/TEN is associated with ARF.…”

Stevens-Johnson Syndrome after Treatment of Female Patient with Small Lymphocytic B-Cell Lymphoma, Autoimmune Hemolytic Anemia and Antiphospholipid Antibody Syndrome with Rituximab

“…Каждый из признаков оценивается в 1 балл. Риск смерти оценивается по сумме баллов: 0-1 балл -≥ 3,2 %; 2 балла -≥ 12,1 %; 3 балла -≥ 35,3 %; 4 балла -≥ 58,3 %; 5 баллов и более -≥ 90 % [9].…”