Neutrophil : lymphocyte ratio is associated with disease severity and mortality in patients with Stevens–Johnson syndrome/toxic epidermal necrolysis

Wang, Qian; Lan, Yue; Qi, Bo; Li, Yin; Zhang, Lixia; Liu, Wei

doi:10.1111/1346-8138.15968

Cited by 17 publications

(14 citation statements)

References 29 publications

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“…However, the inflammatory marker is not an independent risk factor, hence further study in the future is required to validate the observation. 27 …”

Section: Discussionmentioning

confidence: 99%

The Correlation of Neutrophil–Lymphocyte Ratio and Eosinophil Count with SCORTEN in SJS/TEN

Primisawitri¹,

Mawardi²

2022

CCID

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Introduction Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute severe cutaneous adverse reactions commonly caused by medication. Precise evaluation of disease severity in initial setting must be obtained to start appropriate treatment. Neutrophil and lymphocyte ratio (NLR) plays a role in displaying inflammatory reaction while eosinophils count (EC) influences immunological dysregulation including the proliferation of cytotoxic cells in early onset of SJS/TEN. Objective To evaluate whether NLR and EC serve as prognostic markers of disease severity in patients with SJS/TEN using SCORTEN. Methods A single center study with retrospective study included SJS/TEN patients at Dr. Moewardi General Hospital Surakarta in January 1st 2018–December 31st 2020. The required laboratory data was assessed at the beginning of the patient’s admission through medical records. The significance analysis were performed using one-way ANOVA and Spearman while the receiver-operator curve were used to evaluate the prognostic value of variables for severity in SJS/TEN patients. Results The total sample in this study was 24 patients with majority female (58%) and range from 25 to >50 years (54%). The results demonstrated of significant difference and positively correlated between NLR and EC with severity of SJS/TEN (p<0.01; r>0.05). The specificity and sensitivity of 51%;61% and 70%;60%, respectively. Conclusion NLR and EC can be used as prognosticators of severity in SJS/TEN while further research on other inflammatory markers with increased number of samples and study centers are needed to provide more actual data.

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“…However, the inflammatory marker is not an independent risk factor, hence further study in the future is required to validate the observation. 27 …”

Section: Discussionmentioning

confidence: 99%

The Correlation of Neutrophil–Lymphocyte Ratio and Eosinophil Count with SCORTEN in SJS/TEN

Primisawitri¹,

Mawardi²

2022

CCID

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“…In addition, the levels of thymus‐ and activation‐regulated chemokine were positively correlated with NLR in the early stage 29 . In SJS/TEN, NLR was positively correlated with SCORTEN and the age, bicarbonate, cancer, dialysis, and a 10% BSA risk model (ABCD‐10), a 5‐item mortality prediction model for SJS/TEN 15,30 . In our analysis, the serum levels of CCL2 in patients who died were significantly higher than those in patients who survived.…”

Section: Discussionmentioning

confidence: 55%

“…In the severity analysis, the area of skin detachment on admission was significantly correlated with only IL‐8 level, and there was no significant correlation between the area of maximum skin detachment and all cytokines/chemokines (Figure 4b). Interestingly, in terms of clinical parameters, we observed a significant positive correlation between NLR, which is associated with disease severity and mortality in patients with SJS/TEN, 15 and the levels of IL‐6, IL‐8, and CCL2 (Figure 4c).…”

Section: Resultsmentioning

confidence: 85%

Serum levels of C‐C motif chemokine ligand 2 and interleukin‐8 as possible biomarkers in patients with toxic epidermal necrolysis accompanied by acute respiratory distress syndrome

Watanabe

Ikeda

et al. 2022

The Journal of Dermatology

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Toxic epidermal necrolysis (TEN) is a fatal cutaneous adverse reaction that occasionally affects multiple organs. Acute respiratory distress syndrome (ARDS) is a rare complication that can cause rapid and potentially fatal pulmonary dysfunction. However, the mechanisms underlying TEN‐induced ARDS remain unknown. This retrospective single‐center study aimed to identify potential biomarkers for predicting ARDS onset in TEN patients. Pre‐treatment serum samples were collected from 16 TEN patients and 16 healthy controls (HCs). The serum levels of cytokines/chemokines were determined using the Luminex Assay Human Premixed Multi‐analyte kit. The expression levels of cytokines and chemokines in the skin were examined via immunohistochemistry. The serum levels of C‐C motif chemokine ligand 2 (CCL2), interleukin (IL)‐6, and IL‐8 were significantly higher in TEN patients with ARDS than in those without ARDS and in HCs, whereas those of CCL2 and IL‐8 were not significantly different between TEN patients without ARDS and HCs. There was no significant difference in CCL2 and IL‐8 expression in the skin between TEN patients with and without ARDS. Interestingly, there were no significant differences in the cytokine/chemokine levels between TEN and other organ damage, other than ARDS and TEN without any organ damage. We further analyzed the changes in cytokine/chemokine levels before and after treatment in two TEN patients with ARDS. CCL2, IL‐6, and IL‐8 levels decreased after systemic treatment compared to their baseline levels before treatment at an early stage. These results suggest that IL‐8 and CCL2 may be involved in the pathogenesis of TEN‐induced ARDS and have potential application as predictive markers for ARDS onset.

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“…Lymphocytes and neutrophils account for most white blood cells seen in peripheral blood and are frequently used for inflammation and immunological status reflection. NLR is a dependable prognostic indicator and inflammatory marker of SJS/TEN severity, according to these studies 14 . Patients with SJS/TEN often have difficulty in ingesting nutrients orally because of erosion of the oral cavity and esophagus.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of the prognostic nutritional index and red blood cell distribution width‐to‐albumin ratio for the prediction of severity of and mortality associated with Stevens–Johnson syndrome/toxic epidermal necrolysis

Zhang

Jiang

et al. 2022

The Journal of Dermatology

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The prognostic nutritional index (PNI) and red blood cell distribution width-to-albumin ratio (RAR) are considered to be related to the prognosis of disease severity. However, the role of these biomarkers in predicting Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) severity and mortality is unclear. The aim of the current study was to investigate the association of PNI and RAR with severity and mortality in individuals with SJS/TEN. Clinical data were retrospectively collected from 74 individuals with SJS/ TEN and 74 healthy individuals, who were matched for age and sex during the same period. PNI, RAR, and other indicators were compared between individuals with SJS/ TEN and healthy controls. The association of PNI and RAR with SJS/TEN severity was assessed using Spearman or Pearson correlation analyses. Individuals with SJS/TEN were categorized into two groups, either survivors or nonsurvivors. The correlation between PNI, RAR, and SJS/TEN mortality was analyzed using univariate and multivariate logistic regression. The predictive value of the previously mentioned indicators on the mortality of patients with SJS/TEN was assessed using receiver operating characteristic curve analysis. The RAR level of patients with SJS/TEN was greater than that of the control group (p < 0.05), whereas PNI was lower. In compliance with correlation analysis, RAR was positively correlated with SCORTEN (Score of Toxic Epidermal Necrolysis) and ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area) (p < 0.05), and PNI was negatively correlated (p < 0.05). RAR is a risk factor for death in patients with SJS/TEN, but an elevated PNI level is a protective factor for mortality. The best cutoff values of PNI and RAR for predicting death in patients with SJS/TEN were 31.375 (sensitivity, 84.7%; specificity, 80%) and 0.486 (sensitivity, 73.3%; specificity, 84.7%). These results underscore the potential clinical value of PNI and RAR as appropriate and meaningful biomarkers to assess the severity of SJS/TEN and the mortality associated with it.

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Neutrophil : lymphocyte ratio is associated with disease severity and mortality in patients with Stevens–Johnson syndrome/toxic epidermal necrolysis

Cited by 17 publications

References 29 publications

The Correlation of Neutrophil–Lymphocyte Ratio and Eosinophil Count with SCORTEN in SJS/TEN

The Correlation of Neutrophil–Lymphocyte Ratio and Eosinophil Count with SCORTEN in SJS/TEN

Serum levels of C‐C motif chemokine ligand 2 and interleukin‐8 as possible biomarkers in patients with toxic epidermal necrolysis accompanied by acute respiratory distress syndrome

Clinical value of the prognostic nutritional index and red blood cell distribution width‐to‐albumin ratio for the prediction of severity of and mortality associated with Stevens–Johnson syndrome/toxic epidermal necrolysis

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