In-hospital outcomes of SJS/TEN cases in a tertiary center: a 15-year cohort study

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening mucocutaneous reactions. Although SCORTEN remains the most widely used prognostic tool, its performance in real-world settings may vary according to patient population and clinical context. This study evaluated clinical variables associated with in-hospital mortality in SJS/TEN. MATERIALS AND METHODS: We conducted a single-center retrospective cohort study including 20 patients diagnosed with SJS, SJS/TEN overlap, or TEN between January 2010 and December 2024. Clinical and demographic data were extracted, including SCORTEN, mucosal involvement, etiology, comorbidities, treatment modalities, need for intensive care unit (ICU) admission, organ failure, ICU and ward length of stay. Due to the small sample size, statistical comparisons were exploratory and were performed using appropriate exact and non-parametric tests. RESULTS: The in-hospital mortality rate was 40.0% (8/20; exact 95% CI, 19.1%-63.9%). ICU admission occurred in 8/8 non-survivors and 4/12 survivors (absolute difference, 66.7 percentage points; 95% CI, 24.1 to 86.2; p = 0.005). Respiratory failure, dialysis-requiring renal failure, and malignancy each occurred in 4/8 non-survivors and 0/12 survivors (absolute difference for each, 50.0 percentage points; 95% CI, 12.6 to 78.5; p = 0.014 for each), although these outcomes partly overlapped. Among ICU-admitted patients, the median ICU length of stay was 8.5 days in both outcome groups (Hodges-Lehmann difference, 0 days; 95% CI, -9 to 11; p = 0.958). Neither SCORTEN nor TBSA category was significantly associated with mortality. CONCLUSIONS: In this retrospective single-center cohort, ICU requirement, acute organ failure, and underlying malignancy were more frequent among non-survivors with SJS/TEN. Given the limited sample size and absence of multivariable analysis, these findings should be interpreted cautiously. Larger multicenter studies are needed to clarify prognostic factors and real-world clinical course in SJS/TEN.