27 years of a single burn centre experience with Stevens-Johnson syndrome and toxic epidermal necrolysis: analysis of mortality risk for causative agents

Abstract

Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life threatening unwanted side effects, mainly from medication. Pathophysiology is still being debated. The disease usually requires treatment in burn units.

Patients and methods: In a retrospective study over 27 years we evaluated 72 patients admitted with SJS, SJS/TEN and TEN to our burns unit. Patients were evaluated for age, gender, total body surface area (TBSA) involved, causing agents, blood transfusion, dialysis, steroid administration, intubation, length of intensive care stay and death rate. Participants were grouped according to TBSA from 0 to 10, 11 to 30, and 31 to 100% and also into causing agent. Statistical analysis was done using a step-wise regression analysis. Because of small sample sizes for each drug group the percentage of related death rates for each drug group was calculated.

Results: The highest incidence of SJS and TEN was in the age group of 61-70 years. Overall mortality was 38%, mainly due to sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality for causing agents was found from antibiotic treatment, the lowest from using non-steroidal anti-inflammatory drugs. Most transfusions were done in the antibiotic group also the group underwent the highest number of dialysis events. Step-wise regression analysis identified dialysis, mechanical ventilation and age over 65 years as mortality high risk factors.

Conclusion: When SJS/TEN is caused by antibiotics suspicion of developing a fatal sepsis should be high. Patients' medical condition when initiating therapy with a potential causing agent also might influence medical outcome.

Keywords: Causing agent; Death; Relative risk; Stevens–Johnson syndrome; TEN/SJS overlap; Toxic epidermal necrolysis.