Risk factors for sepsis and effects of pretreatment with systemic steroid therapy for underlying condition in SJS/TEN patients: Results of a nationwide cross-sectional survey in 489 Japanese patients. Issue 2 (August 2022)

• Record Type: Journal Article
• Authors: Sunaga, Yuma; Hama, Natsumi; Ochiai, Hirotaka; Kokaze, Akatsuki; Lee, Eun Seon; Watanabe, Hideaki; Kurosawa, Michiko; Azukizawa, Hiroaki; Asada, Hideo; Watanabe, Yuko; Yamaguchi, Yukie; Aihara, Michiko; Mizukawa, Yoshiko; Ohyama, Manabu; Abe, Riichiro; Hashizume, Hideo; Nakajima, Saeko; Nomura, Takashi; Kabashima, Kenji; Tohyama, Mikiko; Takahashi, Hayato; Mieno, Hiroki; Ueta, Mayumi; Sotozono, Chie; Niihara, Hiroyuki; Morita, Eishin; Sueki, Hirohiko
• Is Part Of: Journal of dermatological science. Volume 107:Issue 2(2022)
• Page Start: 75
• Page End: 81
• Publication Date: 2022-08
• Subjects: SJS Stevens-Johnson syndrome -- TEN toxic epidermal necrolysis -- SCARs severe cutaneous adverse reactions -- BSA body surface area -- OR odds ratio -- CI confidential interval -- ICU intensive care unit -- ST sulfamethoxazole-trimethoprim -- Treg regulatory T cells -- non-HIV IRIS immune reconstitution inflammatory syndrome in HIV-negative patients; Stevens-Johnson syndrome (SJS) -- Toxic epidermal necrolysis (TEN) -- Risk factor -- Corticosteroid -- Sepsis; Dermatology -- Periodicals; Skin Diseases -- Periodicals; Dermatologie -- Périodiques; 616.5005
• DOI: 10.1016/j.jdermsci.2022.07.004
• Languages: English
• ISSNs: 0923-1811

Abstract

Abstract: Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening severe cutaneous adverse reactions (SCARs). Sepsis has been shown to be the main cause of death in SJS/TEN. The European SCAR study reported that 14.8 % of SJS/TEN patients were receiving systemic steroid therapy for their underlying condition prior to onset. However, it remained unclear whether this factor affected the mortality rate. Objective: This study was performed to identify risk factors for sepsis in SJS/TEN patients. In addition, we compared patients who had and had not received systemic steroid therapy for their underlying condition. Methods: A primary survey regarding the numbers of SJS/TEN patients between 2016 and 2018 was sent to 1205 institutions in Japan. A secondary survey seeking more detailed information was sent to institutions reporting SJS/TEN patients. We analyzed 315 SJS patients and 174 TEN patients using a logistic regression model, Wilcoxon's rank-sum test, χ 2 test, and Fisher's exact test. Results: Significant risk factors for sepsis included TEN, diabetes, and intensive care unit (ICU) admission. The mortality rate was significantly higher among patients with sepsis. Patients who had received systemic steroid therapy had a lower incidence of fever, and showed a higher mortality rate. Conclusion: Based on a nationwide epidemiological survey of SJS/TEN in Japan, we identified risk factors for sepsis and found that patients who had received steroid therapy for their underlying condition had a lower incidence of fever and a higher mortality rate. Highlights: We conducted a nationwide epidemiological survey of SJS/TEN in Japan. The risk factors for sepsis in SJS/TEN patients were identified. Patients taking steroids for underlying conditions prior to the onset had lower incidence of fever. Patients taking steroids for underlying conditions prior to the onset had higher mortality.