Systematic review and meta-analysis of non-SCORTEN predictors of mortality in Stevens-Johnson syndrome and toxic epidermal necrolysis.

IF 3.5 4区 医学 Q1 DERMATOLOGY
Thomas Jonathan Stewart, Hemali Shah, John Frew
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引用次数: 0

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe cutaneous adverse reactions that result in in-hospital death in 12-49% of cases. The severity-of-illness score for toxic epidermal necrolysis (SCORTEN) is the most widely used mortality prognosis score; however, it has been shown to have critical limitations. Other mortality predictors not incorporated in SCORTEN or other predictor tools are being increasingly reported. This systematic review and meta-analysis aimed to synthesize and evaluate the predictors of mortality in adults with Stevens-Johnson syndrome and toxic epidermal necrolysis not included in SCORTEN. It was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Potential bias was assessed using the National Institutes of Health (NIH) criteria. Forty articles describing results from 52,398 cases were included. Sixteen predictors were reported in five or more articles, and thirty-three were reported in two to four articles. Meta-analysis showed preexisting renal disease (odds ratio (OR): 3.14, 95% confidence interval (CI): 1.99-4.97, P < 0.0001, I2 = 21%), renal involvement (OR: 5.62, 95% CI: 2.29-13.77, P = 0.0002, I2 = 36%), respiratory involvement (OR: 3.14, 95% CI: 1.25-7.92, P = 0.015, I2 = 66%), diabetes mellitus (OR: 1.87, 95% CI: 1.21-2.89, P = 0.005, I2 = 19%), sepsis (OR: 5.64, 95% CI: 2.81-11.29, P < 0.0001, I2 = 63%), comorbidity (OR: 9.13, 95% CI: 4.60-18.12, P < 0.0001, I2 = 0%), and time to hospitalization (OR: 2.56, 95% CI: 1.15-5.65, P = 0.021, I2 = 93) increased risk of mortality. This systematic review and meta-analysis support several clinical and laboratory parameters not included in SCORTEN (preexisting renal disease, renal involvement, respiratory involvement, diabetes mellitus, sepsis, comorbidities, and time to hospitalization) as predictors of mortality in adults with SJS/TEN. The future utilization of these factors may improve mortality prognostication in adults with SJS/TEN.

对史蒂文斯-约翰逊综合征和中毒性表皮坏死症死亡率的非 SCORTEN 预测因素进行系统回顾和荟萃分析。
史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死(TEN)是罕见的严重皮肤不良反应,有 12%-49% 的病例会在院内死亡。中毒性表皮坏死症的疾病严重程度评分(SCORTEN)是最广泛使用的死亡率预后评分,但它已被证明有严重的局限性。其他未纳入 SCORTEN 的死亡率预测指标或其他预测工具的报道也越来越多。本系统综述和荟萃分析旨在综合评估未纳入 SCORTEN 的史蒂文斯-约翰逊综合征和中毒性表皮坏死症成人患者的死亡率预测指标。该研究已在国际注册系统综述和元分析协议平台(INPLASY)注册,并按照系统综述和元分析首选报告项目(PRISMA)报告指南进行。采用美国国立卫生研究院(NIH)标准对潜在偏倚进行了评估。共纳入 40 篇文章,描述了 52,398 个病例的结果。五篇或更多文章中报告了 16 项预测因素,两到四篇文章中报告了 33 项预测因素。Meta 分析显示,已有肾脏疾病(几率比(OR):3.14,95% 置信区间(CI):1.99-4.97,P 2 = 21%)、肾脏受累(OR:5.62,95% CI:2.29-13.77,P = 0.0002,I2 = 36%)、呼吸系统受累(OR:3.14,95% CI:1.25-7.92,P = 0.015,I2 = 66%)、糖尿病(OR:1.87,95% CI:1.21-2.89,P = 0.005,I2 = 19%)、败血症(OR:5.64,95% CI:2.81-11.29,P 2 = 63%)、合并症(OR:9.13,95% CI:4.60-18.12,P 2 = 0%)和住院时间(OR:2.56,95% CI:1.15-5.65,P = 0.021,I2 = 93)增加了死亡风险。该系统综述和荟萃分析支持 SCORTEN 未包括的几项临床和实验室参数(原有肾脏疾病、肾脏受累、呼吸系统受累、糖尿病、败血症、合并症和住院时间)作为 SJS/TEN 成人患者的死亡率预测因素。今后利用这些因素可能会改善成人SJS/TEN患者的死亡率预测。
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来源期刊
CiteScore
4.70
自引率
2.80%
发文量
476
审稿时长
3 months
期刊介绍: Published monthly, the International Journal of Dermatology is specifically designed to provide dermatologists around the world with a regular, up-to-date source of information on all aspects of the diagnosis and management of skin diseases. Accepted articles regularly cover clinical trials; education; morphology; pharmacology and therapeutics; case reports, and reviews. Additional features include tropical medical reports, news, correspondence, proceedings and transactions, and education. The International Journal of Dermatology is guided by a distinguished, international editorial board and emphasizes a global approach to continuing medical education for physicians and other providers of health care with a specific interest in problems relating to the skin.
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