Study Finds a Novel Prognostic Marker for Epidermal Necrolysis
Epidermal necrolysis is a severe cutaneous adverse reaction in which severe systemic inflammation results in extensive epithelial keratinocyte necrosis. In a recent study, researchers have found a novel inflammatory biomarker that improves prognostication of epidermal necrolysis. The study findings were published in the JAMA Dermatology on December 22, 2021.
The Toxic Epidermal Necrolysis Severity Score (SCORTEN) is the most widely used prognostic score for epidermal necrolysis. However, recent studies have shown that SCORTEN overestimated mortality. Identifying independent prognostic markers helps to more accurately stratify risk. Therefore, Dr Haur Yueh Lee and his team conducted a study to evaluate the association between novel inflammatory markers and in-hospital mortality in patients with epidermal necrolysis to study the incremental prognostic value of these markers in combination with SCORTEN.
They conducted the retrospective study, over 17 years from 2003 to 2019 and included 192 patients with Stevens-Johnson syndrome/toxic epidermal necrolysis (median age 56; 59% women), of whom 43 (22.4%) did not survive to discharge. The major outcome assessed was the in-hospital mortality rate. They used the area under the receiver operating characteristic curve (AUC) and calibration plot to assess the discrimination and calibration of risk score. They evaluated the incremental prognostic value of these markers by comparing the AUC between the old and new risk scores and the use of net reclassification improvement and integrated discrimination improvement.
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