Development and validation of prognostic models using novel inflammatory markers for drug reactions with eosinophilia and systemic symptoms: An international multicenter cohort study.

Abstract

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a life-threatening disease that has received little attention focusing on its prognostic markers.

Objective: We evaluated the association between novel inflammatory markers and in-hospital mortality. We also proposed and validated a risk stratification model to aid early intervention.

Methods: This international multicenter, retrospective cohort study included 169 patients diagnosed with DRESS from Taiwan, Singapore, and Japan, collecting demographics and laboratory markers within 3 days of diagnosing DRESS. Inflammatory markers were calculated, and statistical analyses, including logistic regression and receiver operating characteristic curve analysis. Predictive models were developed with internal validation using leave-one-out cross-validation.

Results: Lower hemoglobin-to-red blood cell distribution width ratio, higher platelet-to-lymphocyte ratio, and lower monocyte count are identified as significant predictors of mortality in a multivariate analysis. A predictive model for DRESS-related mortality, incorporating the significant inflammatory markers and underlying disease (malignancy, autoimmune disease, and cardiovascular disease), demonstrated good discrimination ability and acceptable accuracy.

Limitation: The retrospective design, along with factors like interhospital transfers, and underlying malignancies are limitations.

Conclusion: The presence of these novel inflammatory markers and the development of risk stratification model may be of value to stratification of the severity of DRESS.