The Predictive Value of Inflammatory Markers in the Severity and Mortality Risk of Stevens‐Johnson Syndrome/Toxic Epidermal Necrolysis

Red blood cell distribution width-to-platelet ratio (RPR), red blood cell distribution width-to-hemoglobin ratio (RHR), red blood cell distribution width-to-albumin ratio (RAR), and prognostic nutritional index (PNI) have been implicated in disease severity and prognosis. However, their role in predicting severity and mortality in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) remains unclear. This study aimed to investigate the association between RPR, RHR, RAR, PNI and both disease severity and mortality in SJS/TEN patients. In this retrospective study, clinical data from 111 SJS/TEN patients were analyzed. RPR and other laboratory parameters were compared between survivors and non-survivors. The associations of RHR, PNI, RAR, and RPR with SJS/TEN severity were evaluated using Spearman or Pearson correlation analyses. Patients were categorized into survivor and non-survivor groups. Univariate and multivariate logistic regression analyses were employed to examine the correlations between these markers and mortality. The predictive performance of these indicators for SJS/TEN mortality was assessed using receiver operating characteristic (ROC) curve analysis. Correlation analysis revealed that RAR and RHR were positively correlated with SCORTEN, Re-SCORTRN, ABCD-10 and CRISTEN scores (p < 0.05), whereas PNI was negatively correlated (p < 0.05). Correlation analysis revealed that RPR was positively correlated with Re-SCORTRN, ABCD-10 and CRISTEN scores (p < 0.05). RAR, RPR, and RHR were identified as risk factors for mortality in SJS/TEN, while elevated PNI was a protective factor. The optimal cutoff values for RHR and RPR in predicting mortality were 0.13 (sensitivity 75%; specificity 73.6%) and 0.07 (sensitivity 90%; specificity 48.4%), respectively. These findings highlight the potential clinical utility of RHR (AUC = 0.841) and RAR (AUC = 0.729) as meaningful biomarkers for assessing SJS/TEN severity and associated mortality.