Clinical and anamnestic analysis of patients with Stevens–Johnson syndrome/toxic epidermal necrolysis hospitalised in Moscow. Development of a prognostic model of unfavourable outcomes

Ekaterina A. Nikitina; Никитина Екатерина Андреевна; Alexander D. Dushkin; Душкин Александр Дмитриевич; Yuriy V. Streltsov; Стрельцов Юрий Владимирович; Sergey S. Andreev; Андреев Сергей Сергеевич; Tatyana S. Kruglova; Круглова Татьяна Сергеевна; Ulyana A. Markina; Маркина Ульяна Алексеевна; Marina S. Lebedkina; Лебедкина Марина Сергеевна; Maryana A. Lysenko; Лысенко Марьяна Анатольевна; Darya S. Fomina; Фомина Дарья Сергеевна

doi:10.36691/RJA16995

Clinical and anamnestic analysis of patients with Stevens–Johnson syndrome/toxic epidermal necrolysis hospitalised in Moscow. Development of a prognostic model of unfavourable outcomes

Authors: Nikitina E.A.¹^,2, Dushkin A.D.¹^,3^,4, Streltsov Y.V.¹, Andreev S.S.¹, Kruglova T.S.¹, Markina U.A.¹, Lebedkina M.S.¹, Lysenko M.A.¹^,5, Fomina D.S.¹^,2^,6
Affiliations:
1. Moscow City Hospital 52
2. The First Sechenov Moscow State Medical University (Sechenov University)
3. National Medical Research Center for High Medical Technologies — Central Military Clinical Hospital named after A.A. Vishnevsky
4. S.M. Kirov Military Medical Academy
5. The Russian National Research Medical University named after N.I. Pirogov
6. Astana Medical University
Issue: Vol 22, No 3 (2025)
Pages: 233-247
Section: Original studies
URL: https://journals.rcsi.science/raj/article/view/346896
DOI: https://doi.org/10.36691/RJA16995
ID: 346896

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Abstract

BACKGROUND: Stevens–Johnson syndrome and toxic epidermal necrolysis are severe life-threatening conditions characterized by massive lesions of the skin and mucosa. At present, considering the high mortality rate, one of the most promising areas of research is the study of predictors of the severity of the pathology, since prognosis of the disease can further influence the choice of treatment strategy.

AIM: Determination of epidemiological features, identification of clinical and laboratory predictors of the disease severity, and construction of a prognostic model for patients with Stevens–Johnson syndrome and toxic epidermal necrolysis within the framework of analysis of electronic medical records of Moscow.

MATERIALS AND METHODS: The study was based on a retrospective analysis of medical records of patients with SJS/TEN from 2020 to 2023. Initially, 230 individuals over 18 years of age were included in the analysis. As a result of selection from the primary cohort, 122 patients satisfying the criteria for the diagnosis of Stevens–Johnson syndrome and toxic epidermal necrolysis were included in the final analysis. Patients did not undergo additional follow-up as part of this study.

RESULTS: In the analyzed cohort, a prevalence of female patients (n = 72; 59.01 %) over male patients (n = 50; 40.99 %) was observed. Lethal outcome was recorded in 27 (22.13 %) patients, of which 21 (77.8 %) had a verified diagnosis of toxic epidermal necrolysis, which was associated with a higher incidence of death compared to Stevens–Johnson syndrome (n = 6 (p = 0.001)). It was found that 112 (91.8 %) cases were likely associated with medication use, while 10 (8.2 %) presented a verified infectious agent Mycoplasma pneumoniae. Antiepileptic drugs were the most frequent cause of drug-induced Stevens–Johnson syndrome/toxic epidermal necrolysis (n = 62; 55.4 %). Based on the analysed clinical and laboratory data, a prognostic model was developed to determine the probability of lethal outcome, including decreased serum bicarbonate, increased levels of c-reactive protein, fibrinogen, fever, hypoalbuminemia.

CONCLUSION: Stevens–Johnson syndrome and toxic epidermal necrolysis are rare conditions with a high mortality rate and high risk of disabling complications. Early verification of the diagnosis and stratification of patients by severity group is optimal for the choice of treatment tactics; however, further work is currently required to standardise the assessment of the severity of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.

Keywords

Stevens–Johnson syndrome, toxic epidermal necrolysis, predictive modelling, anticonvulsant

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MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow; Moscow

Darya S. Fomina

Moscow City Hospital 52; The First Sechenov Moscow State Medical University (Sechenov University); Astana Medical University

Email: daria_fomina@mail.ru
ORCID iD: 0000-0002-5083-6637
SPIN-code: 3023-4538

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Moscow; Moscow; Republic of Kazakhstan, Astana

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