Toxic epidermal necrolysis data from the CELESTE multinational registry. Part II: Specific systemic and local risk factors for the development of infectious complications

Lipový, Břetislav; Holoubek, Jakub; Hanslianová, Markéta; Cvanová, Michaela; Klein, Leo; Grossová, I; Zajíček, Robert; Bukovčan, Peter; Koller, Ján; Baran, Matúš; Lengyel, Péter; Eimer, L; Jandová, Marcela; Košťál, Milan; Brychta, Pavel

doi:10.1016/j.burns.2018.03.006

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…The EuroSCAR cohort study found a lower mortality in 40 patients treated with IVIG + CE compared with 35 patients treated with IVIG alone (mortality 18% vs 34%, respectively) 53 . Other combinations of treatments have also been explored for which there may be conclusive data in the future 65,66 …”

Section: Discussionmentioning

confidence: 99%

Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis

Torres‐Navarro

Briz‐Redón

Botella‐Estrada

2020

Acad Dermatol Venereol

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BackgroundThe SCORTEN score is a specific predictor of mortality for patients with Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). There is little evidence in support of the common immunomodulating therapies for SJS/TEN.ObjectivesTo systematically assess the effectiveness of several therapies for SJS/TEN through the SCORTEN score.MethodsDatabases were searched for original studies on the use of SCORTEN. Six meta‐analyses were carried out on patients with SJS/TEN who received supportive care only or in combination with immunomodulating drugs: corticosteroids, cyclosporine, etanercept, immunoglobulins or a combination of corticosteroids with immunoglobulins. A multivariate meta‐regression and a network meta‐analysis were also performed.ResultsOf 3893 studies identified, fifty‐two involving 2466 patients with SJS/TEN were preselected. Data from thirty‐eight of these studies (1827 patients) were finally pooled, and results [log(SMR)] from meta‐analyses were as follows: −0.13 (95% CI, −0.42,0.16) for corticosteroids, −0.39 (95% CI, −0.87,0.09) for immunoglobulins, 0.13 (95% CI, −0.15,0.40) for supportive treatment, −0.88 (95% CI, −1.47, −0.29) for cyclosporine, −0.95 (95% CI, −1.82, −0.07) for etanercept and − 0.56 (95% CI, −0.94, −0.19) for immunoglobulins plus corticosteroids. The meta‐regression analysis confirmed that cyclosporine and immunoglobulins plus corticosteroids were associated with less deaths than predicted by SCORTEN. In the network meta‐analysis, no treatment achieved a significant reduction in the SMR.LimitationsHeterogeneity and quality of the included studies.ConclusionsSome treatments for SJS/TEN show a better performance, but there is not sufficient evidence to recommend its widespread use in all patients.

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Section: Discussionmentioning

confidence: 99%

Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis

Torres‐Navarro

Briz‐Redón

Botella‐Estrada

2020

Acad Dermatol Venereol

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“…21 Studi Lipovy dkk (2018) tidak menilai secara spesifik faktor risiko terjadinya bakteremia pada pasien SSJ-NET. 23 Studi tersebut menilai tiga faktor risiko potensial terjadinya bakteremia yaitu SCORTEN, lama rawat atau length of stay (LOS), serta waktu antara awitan gejala dan rujukan ke unit luka bakar. Terdapat hubungan yang bermakna antara LOS dengan kejadian bakteremia.…”

Section: Diskusiunclassified

Faktor Risiko Prediktor Bakteremia pada Pasien Nekrolisis Epidermal: Evidence-Based Case Report

Anindya¹,

Muhammad²,

Budianti³

2022

J. Kdokt Meditek

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Nekrolisis epidermal (NE) yang terbagi atas Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan reaksi simpang obat berat dengan mortalitas tinggi. Penyebab kematian terbanyak pada NE adalah sepsis, namun gejala sepsis tidak spesifik pada NE dan hasil kultur darah membutuhkan waktu lama. Oleh karena itu penting mengetahui prediktor yang berpengaruh terhadap peningkatan risiko bakteremia pada pasien dengan NE. Evidence-based case report ini bertujuan mengetahui faktor prediktor terjadinya bakteremia pada pasien NE berdasarkan literatur. Pencarian artikel menggunakan basis data PubMed, Cochrane, dan Scopus yang relevan dengan pertanyaan klinis untuk kemudian ditelaah. Didapatkan dua artikel kohort yang sesuai. Studi Koh dkk. mendapatkan tiga prediktor yang berpengaruh terhadap kejadian bakteremia pada pasien NE; yaitu hemoglobin ≤ 10 g/dL (odds ratio [OR] 2,4; interval kepercayaan [IK] 95% 2,2-2,6), luas epidermolisis ≥ 10% (OR 14,3; IK 95% 13,4-15,2) dan penyakit komorbid kardiovaskular (OR 2,1; IK 95% 2,0-2,3). Studi De Prost dkk. mendapatkan tiga prediktor yaitu usia > 40 tahun (hazard ratio [HR] 2,5; IK 95% 1,35-4,63), leukosit > 10.000/mm3 (HR 1,9; IK 95% 0,96-3,61), serta LPB ≥ 30% (HR 2,5; IK 95% 1,13-5,47). Epidermolisis yang lebih luas merupakan faktor prediktor terjadinya bakteremia pada NE di kedua studi. Faktor risiko lainnya memerlukan penelitian lebih lanjut.

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“…Where delayed reactions occur, TEN patients have a higher risk of developing acute renal failure (particularly when sepsis and capillary-leak syndrome develop and in cases with insufficient fluid resuscitation), and a higher risk of pulmonary complications (including infections in the lower respiratory tract), depending on the severity of the endothelial damage. 82,83 Such patients can be also more susceptible to the development of thromboembolic complications. IVIg administration significantly increases these risks, which should be taken into account and a prophylaxis protocol for reduction of the incidence of these complications in TEN patients should be employed (e.g.…”

Section: Hepatic Dysfunctionmentioning

confidence: 99%

“…fever, tachycardia, hypotension or skin rash). Where delayed reactions occur, TEN patients have a higher risk of developing acute renal failure (particularly when sepsis and capillary‐leak syndrome develop and in cases with insufficient fluid resuscitation), and a higher risk of pulmonary complications (including infections in the lower respiratory tract), depending on the severity of the endothelial damage 82,83 . Such patients can be also more susceptible to the development of thromboembolic complications.…”

Section: Therapeutic Concepts Of Ivig In Patients With Tenmentioning

confidence: 99%

Responsiveness to i.v. immunoglobulin therapy in patients with toxic epidermal necrolysis: A novel pharmaco‐immunogenetic concept

Linhartová

Gachova

Lipový

2020

The Journal of Dermatology

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Toxic epidermal necrolysis (TEN) represents a rare drug‐induced autoimmune reaction with delayed‐type hypersensitivity that initiates the process of developing massive keratinocyte apoptosis, dominantly in the dermoepidermal junction. Although the etiopathophysiology has not yet been fully elucidated, the binding of Fas ligand (FasL, CD95L) to the Fas receptor (CD95) was shown to play a key role in the induction of apoptosis in this syndrome. The knowledge of the role of immunoglobulin G (IgG) in inhibition of Fas‐mediated apoptosis contributed to the introduction of i.v. Ig (IVIg) in the therapy of TEN patients. Despite great enthusiasm for this therapy at the end of the 1990s, subsequent studies in various populations and meta‐analyses could not unequivocally confirm the efficacy of the IVIg‐based treatment concept. Today, therefore, we are faced with the dilemmas of how to adjust therapy of TEN patients most effectively, which patients could benefit from IVIg therapy and what dose of the preparation should be administrated. The ground‐breaking question is: do the host genetic profiles influence the responsiveness and side‐effects of IVIg therapy in TEN patients? Based on recent pharmacological, immunological and genetic findings, we suggest that the variability of IVIg therapy outcomes in TEN patients may be related to functional variants in Fas, FasL and Fc‐γ receptor genes. This novel concept could lead to improved quality of care for patients with TEN, facilitating personalized therapy to reduce mortality.

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Toxic epidermal necrolysis data from the CELESTE multinational registry. Part II: Specific systemic and local risk factors for the development of infectious complications

Cited by 8 publications

References 30 publications

Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis

Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis

Faktor Risiko Prediktor Bakteremia pada Pasien Nekrolisis Epidermal: Evidence-Based Case Report

Responsiveness to i.v. immunoglobulin therapy in patients with toxic epidermal necrolysis: A novel pharmaco‐immunogenetic concept

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