A cross-sectional analysis of inflammatory markers as a severity and prognostic indicator in severe cutaneous adverse drug reactions.

Abstract

Background The inflammatory markers (IMs) are a set of biomarkers used clinically to assess a patient for the presence of an active inflammatory disease or disease activity. They are elevated in conditions like infections, malignancies, mental illness and drug reactions among others. Aim The study aimed at identifying the IMs that reflect the severity and recovery in severe cutaneous adverse drug reactions (SCARs). Methods A cross-sectional observational study was conducted among patients with SCARs (Stevens Johnson syndrome [SJS]/ toxic epidermal necrolysis [TEN] and drug reaction with eosinophilia and systemic symptoms [DRESS]) admitted to a tertiary care hospital over 18 months. Results Twenty SJS/TEN and 8 DRESS cases were included in the study. There were more females in the study (F: M = 2:1). Comparing the IMs of SJS/TEN and DRESS revealed that most markers on day 7 were lower as compared to day 0. There was a significant difference in eosinophil count (EC), procalcitonin (PCT) (p-value <0.05), and recovery time between the two groups. In the SJS/TEN group, markers like ferritin (>2000 ng/mL) and PCT (>2.0 ng/mL) were significantly higher, around the septic range, in patients with concurrent connective tissue disease and culture positivity. Ferritin (p-value- 0.025, rho- 0.578), PCT (p-value- 0.013, rho- 0.239), and ESR (p-value- 0.041, rho- 0.482) were associated with the severity of SJS/TEN. Patients with DRESS had an early recovery with a statistically significantly shorter hospital stay than SJS/TEN (p<0.005). Baseline severity-of-illness score for TEN levels, total counts, and day 7 PCT significantly reflected the time taken for recovery. Limitations Marker analysis was performed at baseline and on day 7 of admission, but not after complete clinical recovery, therefore indicating a trend but limited conclusive behaviour of markers at the time of recovery. Conclusion The progression of IMs in a SCAR follows the clinical course of the illness. IMs like ferritin and PCT, along with routine haematological investigation, aid in identifying the severity, differentiating it among patients with comorbidities, and helping predict the recovery time in SCARs.