Cohort study of patients with Stevens–Johnson syndrome and toxic epidermal necrolysis in China: evaluation of risk models and new predictor of pulmonary consolidation on computed tomography
Cohort study of patients with Stevens–Johnson syndrome and toxic epidermal necrolysis in China: evaluation of risk models and new predictor of pulmonary consolidation on computed tomography
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中国史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症患者队列研究：计算机断层扫描肺实变风险模型和新预测因子的评估
DOI：
10.1007/s11684-020-0817-2
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发表时间：
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影响因子：
8.1
通讯作者：
Jinhua Xu
中科院分区：
文献类型：
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作者：
Yanhong Shou;Lu Yang;Yongsheng Yang;Jinhua Xu
史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死松解症(TEN)是罕见但严重的疾病。本研究旨在验证风险模型在SJS/TEN患者中的预测能力，并在中国的研究中提出可能的改进。纳入华山医院皮肤科2008-01/2019年1月的患者。结果表明，TEN的病情严重程度评分(SCORTEN)具有较好的区分性(受试者工作特征曲线下面积(AUC)为0.78)，优于辅助评分(AS)和ABCD-10(反映年龄、碳酸氢盐水平、癌症、透析和10%累及体表面积)(AUC分别为0.69和0.68)。SCORTEN(Hosmer-Lemesow拟合度检验，P=0.69)的校正效果也好于AS(P=0.25)和ABCD-10(P=0.55)。SCORTEN和ABCD-10在预测准确性方面相似(Brier评分，BS分别为0.04和0.04)。此外，CT上肺实变的影像表现与高死亡率有关。使用这些变量和这种成像外观形成了精细化的模型。改进的AS和ABCD-10模型与原SCORTEN模型相比，其判别能力相似(分别为0.74比0.78，P=0.23；0.74比0.78，P=0.30)。因此，SCORTEN显示出良好的判别性能、校准和准确性，当SCORTEN变量不可用时，改进的AS或ABCD-10模型可能是一种选择。
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe diseases. This study aimed to validate the predictive ability of risk models in patients with SJS/TEN and propose possible refinement in China. Patients in the Department of Dermatology of Huashan Hospital from January 2008 to January 2019 were included. Results showed that the severity-of-illness score for TEN (SCORTEN) had a good discrimination (area under the receiver operating characteristic curve (AUC), 0.78), and it was superior to auxiliary score (AS) and ABCD-10, which indicates age, bicarbonate level, cancer, dialysis, and 10% involved body surface area (AUC, 0.69 and 0.68, respectively). The calibration of SCORTEN (Hosmer-Lemeshow goodness-of-fit test,P= 0.69) was also better than that of AS (P= 0.25) and ABCD-10 (P= 0.55). SCORTEN and ABCD-10 were similar (Brier score (BS), 0.04 and 0.04) in terms of accuracy of predictions. In addition, the imaging appearance of pulmonary consolidation on computed tomography was associated with high mortality. Refined models were formed using the variables and this imaging appearance. The refined AS and ABCD-10 models were similar in discrimination compared with the original SCORTEN (0.74 vs. 0.78,P= 0.23; 0.74 vs. 0.78,P= 0.30, respectively). Therefore, SCORTEN showed good discrimination performance, calibration, and accuracy, and refined AS or ABCD-10 model may be an option when SCORTEN variables are not available.