TY - JOUR
T1 - Risk factors and mortality among patients with severe muco-cutaneous drug reactions
AU - Crüger, Anne-Mette Torp
AU - Kaur-Knudsen, Diljit
AU - Zachariae, Claus
AU - Rasmussen, Henrik Berg
AU - Thomsen, Simon Francis
PY - 2015/8
Y1 - 2015/8
N2 - INTRODUCTION: The aim of this study was to examine risk factors and mortality among patients with erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).METHODS: This was a retrospective evaluation of the med-ical records of 250 patients from two Danish tertiary dermatological departments during a ten-year period.RESULTS: In a total of 192 cases (77.4%), the primary diagnosis of EM (66.5%), SJS (62.2%) and TEN (100%) was confirmed, whereas the remaining cases (22.6%) were diagnosed differently. Antibiotics and allopurinol were predominantly associated with TEN, whereas SJS was associated with a broad spectrum of drugs. EM was related mainly to viral infections, predominantly herpes (30.6%); 38.2% of the causes of EM remained unknown. Patients with TEN had the highest mortality; i.e. 60% in the course of the ten-year study period: adjusted hazard ratio (HR) = 11.2 (95% confidence interval (CI): 3.65-34.35); p < 0.001 compared with EM patients. The risk of death was also increased among patients with SJS relative to patients with EM: HR = 2.60 (95% CI: 1.10-6.16); p = 0.030; however, this did not remain statistically significant after adjustment for age, co-morbidity, infection, cancer and polypharmacy, HR = 0.99 (95% CI: 0.38-2.57); p = 0.976.CONCLUSION: We validated diagnoses in 250 patients with EM, SJS and TEN diagnosed during a ten-year period. The survival of patients with TEN was expectedly low compared with patients with EM. We extend previous findings by showing that after adjustment for confounders, the survival rates of SJS and EM are comparable.FUNDING: none.TRIAL REGISTRATION: not relevant.
AB - INTRODUCTION: The aim of this study was to examine risk factors and mortality among patients with erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).METHODS: This was a retrospective evaluation of the med-ical records of 250 patients from two Danish tertiary dermatological departments during a ten-year period.RESULTS: In a total of 192 cases (77.4%), the primary diagnosis of EM (66.5%), SJS (62.2%) and TEN (100%) was confirmed, whereas the remaining cases (22.6%) were diagnosed differently. Antibiotics and allopurinol were predominantly associated with TEN, whereas SJS was associated with a broad spectrum of drugs. EM was related mainly to viral infections, predominantly herpes (30.6%); 38.2% of the causes of EM remained unknown. Patients with TEN had the highest mortality; i.e. 60% in the course of the ten-year study period: adjusted hazard ratio (HR) = 11.2 (95% confidence interval (CI): 3.65-34.35); p < 0.001 compared with EM patients. The risk of death was also increased among patients with SJS relative to patients with EM: HR = 2.60 (95% CI: 1.10-6.16); p = 0.030; however, this did not remain statistically significant after adjustment for age, co-morbidity, infection, cancer and polypharmacy, HR = 0.99 (95% CI: 0.38-2.57); p = 0.976.CONCLUSION: We validated diagnoses in 250 patients with EM, SJS and TEN diagnosed during a ten-year period. The survival of patients with TEN was expectedly low compared with patients with EM. We extend previous findings by showing that after adjustment for confounders, the survival rates of SJS and EM are comparable.FUNDING: none.TRIAL REGISTRATION: not relevant.
KW - Adult
KW - Allopurinol
KW - Anti-Bacterial Agents
KW - Antimetabolites
KW - Denmark
KW - Erythema Multiforme
KW - Female
KW - Herpes Simplex
KW - Humans
KW - Male
KW - Middle Aged
KW - Pneumonia, Mycoplasma
KW - Proportional Hazards Models
KW - Retrospective Studies
KW - Risk Factors
KW - Stevens-Johnson Syndrome
M3 - Journal article
C2 - 26239591
SN - 2245-1919
VL - 62
SP - 1
EP - 5
JO - Danish Medical Journal
JF - Danish Medical Journal
IS - 8
M1 - A5122
ER -