A new risk prediction model for in-hospital mortality was developed for patients with Stevens-Johnson syndrome/toxic epidermal necrolysis that is more accurate and had similar discrimination when compared with the standard prediction model, according to a study published in JAMA Dermatology.

Researchers developed an in-hospital mortality novel prognostic model using 5 independent predictor covariates measured at admission to calculate a severity-of-illness score for patients with Stevens-Johnson syndrome/toxic epidermal necrolysis. Demographics, medications, comorbidities, laboratory data, physical examinations, treatment regimens, and outcomes were collected from inpatient consult databases and electronic medical record systems for patients presenting with Stevens-Johnson syndrome/toxic epidermal necrolysis.

Of the 370 patients included in this study, 52.7% were women and the mean age was 49 years.  The median body surface area involved was 15.5%. Of the patients included in the study, 15.1% did not survive until hospital discharge. Using multivariable logistic regression, an age of ≥50 years, serum bicarbonate level lower than 20 mmol/L, active cancer presence, dialysis prior to admission, and >10% of body surface area included in epidermal detachment were found to be independently associated factors of in-hospital mortality. The model was named ABCD-10, for each of the included predicting variables (age, bicarbonate level, cancer, dialysis, and 10% of involved body surface area). The model showed excellent predictive ability based on a low Brier score (0.1484), good discrimination based on the area under the receiver operating characteristic curve (0.816; 95% CI, 0.759-0.872), and good calibration based on the Hosmer-Lemeshow goodness of fit test (P =.03).

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Limitations of this study include the study hospitals being tertiary care facilities, heterogeneity in the assessment of epidermal detachment, and the treatment protocol not being standardized.

The researchers concluded that, for “patients with [Stevens-Johnson syndrome/toxic epidermal necrolysis], ABCD-10 accurately predicted in-hospital mortality, with discrimination that was not significantly different from [Score of Toxic Epidermal Necrolysis].”

Disclosures: authors report multiple associations with pharmaceutical companies. Please refer the original reference for a full list of authors’ disclosures.

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Reference

Noe MH, Rosenbach M, Hubbard RA, et al. Development and validation of a risk prediction model for in-hospital mortality among patients with Stevens-Johnson syndrome/toxic epidermal necrolysis—ABCD-10 [published online March 6, 2019]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.5605