Predictors of Survival and Length of Stay in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Single-Center Retrospective Study of 111 Patients

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) comprise a spectrum of severe mucocutaneous drug reactions associated with significant morbidity and mortality. Current prognostication of survival and length of stay is imprecise and unreliable across different populations. We assessed and quantified patient, disease and management factors associated with survival and length of stay in an Australian cohort of adults with SJS/TEN. We reviewed 16 years of Stevens Johnson syndrome and toxic epidermal necrolysis cases at a large tertiary referral centre in Australia. Collated variables were demographics, comorbidities, disease-specific, laboratory results, treatments, complications, and mortality. 111 cases of Stevens Johnson syndrome or toxic epidermal necrolysis were included. Older age (p<0.01), delayed presentation (p=0.012), higher SCORTEN (p<0.01), heart rate above 120 beats per minute (p<0.01), septicemia (p<0.01), urogenital involvement (p=0.013) and intensive care admission (p<0.01) were predictive of non-survival, with only more than one culprit drug (p=0.02) retaining its significance on covariate analysis. Ocular (p<0.01), oral (p=0.014) and urogenital mucosal involvement (p<0.01), as well as chronic pain (p<0.01) were predictive of longer length of stay on univariate analysis, whilst a central line (p=0.017), parenteral analgesia (p=0.024) and neutropenia (p=0.02) were predictive on covariate analysis. Intravenous immunoglobulin was shown to reduce length of stay (p=0.046). Study limitations included retrospective design, data from a single referral centre, as well as sampling and recall bias. Our study identified several well-established, less explored, and novel predictors of survival and length of stay in adults with SJS/TEN, which may serve to inform future prognostication tools and research.