Long-term cardiovascular outcomes among adult survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective cohort study using TriNetX

Abstract

Background: The long-term sequelae of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are increasingly being recognized. However, few studies have evaluated the long-term risk of cardiovascular diseases in these patients.

Objectives: This study aimed to investigate the long-term cardiovascular outcomes in survivors of SJS/TEN.

Methods: In total, 2738 SJS/TEN survivors and 2738 propensity-score-matched controls were enrolled from the US Collaborative Network in the TriNetX database. The primary outcome of this study was the development of a major cardiovascular event (MACE). Patients were followed up from 3 months after the index date until the first diagnosis of an outcome event, withdrawal from the database, or 5 January 2025.

Results: We found that SJS/TEN survivors had a significantly elevated risk of MACE [hazard ratio (HR) 2.13], ischaemic heart disease (HR 1.57), cerebrovascular disease (HR 2.13) and mortality (HR 1.94) compared with the matched healthy controls. Additionally, the association remained significant in most stratifications, including female, different age groups, disease severity (SJS, SJS/TEN overlap syndrome and TEN) and initial hospitalization status.

Conclusions: Some potential confounders may not be acquired in the database. In addition, detection bias is another potential source of bias in this study. This study revealed that SJS/TEN survivors have a significantly higher long-term risk of developing MACE. Understanding these sequelae may provide insights for the holistic care of SJS/TEN survivors.