Are Novel Inflammatory Markers Prognostic for Mortality in Epidermal Necrolysis?

Red cell distribution width to hemoglobin ratio shows similar predictive ability to SCORTEN; better discrimination with composite

By Dermsquared Editorial Team | December 22, 2021

Measurement of red cell distribution width to hemoglobin ratio (RDW/Hb) shows similar predictive ability to the Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) for mortality in epidermal necrolysis, and the composite measure (Re-SCORTEN) has better discrimination, according to a study published online Dec. 22 in JAMA Dermatology.

Hui Kai Koh, M.B.B.S., from Singapore General Hospital, and colleagues conducted a retrospective cohort study from 2003 to 2019 to examine the association between novel inflammatory markers and in-hospital mortality in patients with epidermal necrolysis. The incremental value of these markers in combination with SCORTEN was examined among 192 patients.

Of the 192 patients, 43 (22.4 percent) did not survive to discharge. The researchers found that after adjustment for SCORTEN, only RDW/Hb significantly predicted in-hospital mortality (odds ratio, 3.55). The RDW/Hb as applied in four risk groups had similar discrimination to SCORTEN (area under the receiver operating characteristic curve [AUC], 0.76 versus 0.78). Significantly better discrimination was seen with the addition of RDW/Hb to SCORTEN (Re-SCORTEN) versus SCORTEN alone (AUC, 0.83 versus 0.78). The overall net reclassification index was 0.94, and the integrated discrimination improvement was 0.06.

"Accurate risk stratification is integral in improving patient evaluation and management and more precise estimation of survival benefits associated with immunomodulatory therapy," the authors write. "Future studies may consider validating the use of RDW/Hb and the composite model of Re-SCORTEN in prognostication of mortality in other cohorts of Stevens-Johnson syndrome/toxic epidermal necrolysis."

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