Performance of ABCD-10 and SCORTEN mortality prediction models in a cohort of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis

Duplisea, Michael; Roberson, Mya L.; Chrisco, Lori; Strassle, Paula D.; Williams, Felicia N.; Ziemer, Carolyn

doi:10.1016/j.jaad.2021.04.082

Cited by 18 publications

(19 citation statements)

References 11 publications

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“…Some previous studies compared these two models on the prognosis of SJS/TEN, all suggesting a better performance of SCORTEN than ABCD‐10 in the prognosis of TEN. Even in side‐effects prediction, SCORTEN performed better than ABCD‐10 36–38 . Consequently, the status of SCORTEN in the SJS/TEN prognosis remains irreplaceable until a more appropriate model is defined.…”

Section: Discussionmentioning

confidence: 99%

“…Even in side-effects prediction, SCORTEN performed better than ABCD-10. [36][37][38] Consequently, the status of SCORTEN in the SJS/TEN prognosis remains irreplaceable until a more appropriate model is defined. In our cohort, no patients received dialysis, so the ABCD-10 model was not evaluated in this study.…”

Section: Ta B L Ementioning

confidence: 99%

“…SCORTEN is the most widely used model in SJS/TEN and was first introduced by Sylvie et al in 2000 to predict the death rate of TEN 15. It has now been validated by many studies, showing satisfactory prediction efficacy [36][37][38]. In our study, we conducted the generalized linear model, hoping to find some risk factors associated with TEN death and recovery.…”

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confidence: 97%

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Combined use of cyclosporine in the treatment of Stevens–Johnson syndrome/toxic epidermal necrolysis

Chen

Pan

et al. 2022

The Journal of Dermatology

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Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) still ranks as one of the most critical diseases in dermatology. 1,2 It has now been clarified that SJS and TEN represent a spectrum of life-threatening mucocutaneous reactions, of which TEN is thought to be a more severe stage of SJS, presenting as a total body surface area (BSA) detached of more than 30% in contrast to <10% in SJS. 3,4 Although the incidence rate of SJS/TEN was 1-2 cases per million, the mortality rate could reach 30%-50%, as previously reported. 5,6 In addition, severe skin lesions, which are characterized by morbilliform erythema, progressive epidermal necrosis, and skin detachment, add great burdens to patients physically, mentally, and economically. 1,7 However, the optimal interventions in the treatment of SJS/TEN are unknown. The low incidence has limited the number of studies, so more clinical observations and research should be reported.Currently, the management of SJS/TEN is mainly symptomatic supportive care with special attention to skin/mucosa care and infection prevention. 8,9 However, in terms of treatment drugs, the

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L Ementioning

confidence: 99%

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Combined use of cyclosporine in the treatment of Stevens–Johnson syndrome/toxic epidermal necrolysis

Chen

Pan

et al. 2022

The Journal of Dermatology

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“…While ABCD-10 has good discriminatory ability, multiple studies have showed that it underperforms in comparison to SCORTEN ( 3 , 7 , 15 , 16 ). Specifically, one retrospective cohort study in Singapore found that in both patients treated with supportive care or immunomodulatory therapy, ABCD-10 underestimated mortality at lower score ranges and overestimated mortality at higher score ranges ( 15 ).…”

Section: Strengths and Weaknesses Of Abcd-10mentioning

confidence: 99%

“…Epidermal necrolysis, the unifying term for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is a severe cutaneous drug reaction associated with high morbidity and mortality ( 1 – 3 ). It is considered to be the most life-threatening dermatologic disease with a mortality incidence of 15% overall, and up to 50% in the elderly ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Scoring Assessments in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

et al. 2022

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Epidermal necrolysis, the unifying term for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is a severe cutaneous drug reaction associated with high morbidity and mortality. Given the rarity of this disease, large-scale prospective research studies are limited. Significant institutional and geographical variations in treatment practices highlight the need for standardization of clinical assessment scores and prioritization of research outcome measures in epidermal necrolysis. At the present, clinical assessment is typically simplified to total body surface area (BSA) involvement, with little focus on morphology. Validated clinical scoring systems are used as mortality prognostication tools, with SCORTEN being the best-validated tool thus far, although the ABCD-10 has also been recently introduced. These tools are imperfect in that they tend to either overestimate or underestimate mortality in certain populations and are not designed to monitor disease progression. Although mortality is often used as a primary endpoint for epidermal necrolysis studies, this outcome fails to capture more nuanced changes in skin disease such as arrest of disease progression while also lacking a validated skin-directed inclusion criterion to stratify patients based on the severity of skin disease at study entry. In addition to mortality, many studies also use BSA stabilization or time to re-epithelialization as endpoints, although these are not clearly defined morphologically, and inter- and intra-rater reliability are unclear. More specific, validated cutaneous assessment scores are necessary in order advance therapeutic options for epidermal necrolysis. In this review, we summarize the strengths and weaknesses of current clinical assessment practices in epidermal necrolysis and highlight the need for standardized research tools to monitor cutaneous involvement throughout the hospitalization.

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Update on Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management

Shah,

Parisi,

Mukherjee

et al. 2024

Am J Clin Dermatol

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Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the most severe cutaneous adverse reactions that are typically drug-induced in adults. Both SJS and TEN have high morbidity and mortality rates. SJS/TEN imposes clinical challenges for physicians managing patients suffering from this condition, both because it is rare and because it is a rapidly progressing systemic disease with severe cutaneous, mucosal, and systemic manifestations. Although many cases of SJS/TEN have been reported in the literature, there is no consensus regarding diagnostic criteria or treatment. Significant progress has been made in understanding its genetic predisposition and pathogenesis. This review is intended to provide physicians with a comprehensive but practical SJS/TEN roadmap to guide diagnosis and management. We review data on pathogenesis, reported precipitating factors, presentation, diagnosis, and management SJS/TEN focusing on what is new over the last 5 years.

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Performance of ABCD-10 and SCORTEN mortality prediction models in a cohort of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis

Cited by 18 publications

References 11 publications

Combined use of cyclosporine in the treatment of Stevens–Johnson syndrome/toxic epidermal necrolysis

Combined use of cyclosporine in the treatment of Stevens–Johnson syndrome/toxic epidermal necrolysis

Scoring Assessments in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Update on Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management

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