Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults
Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults
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DOI：
10.1016/j.jid.2016.03.023
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发表时间：
2016-07-01
影响因子：
6.5
通讯作者：
Silverberg, Jonathan I.
中科院分区：
文献类型：
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作者：
Hsu, Derek Y.;Brieva, Joaquin;Silverberg, Jonathan I.
史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死松解症(TEN)是威胁生命的疾病。我们的研究目标是描述SJS和TEN在美国成年人中的发病率、护理费用、住院时间、合并症和死亡率。分析了2009-2012年全国住院患者样本，其中包含美国所有住院患者的20%样本。我们使用一种有效的方法，包括国际疾病分类第9版，临床修改代码来识别SJS，SJS/TEN和TEN(分别为2,591，n=502和n=564)。SJS、SJS/TEN和TEN的平均估计发病率分别为每年每百万成人9.2、1.6和1.9。SJS/TEN与非白人相关，特别是亚洲人(优势比=3.27，95%可信区间=3.02-3.54)和黑人(优势比=2.01，95%可信区间=1.92-2.10)。住院时间和护理费用(SJS：9.8+/-0.3天，21,437+/-807美元；SJS/TEN：16.5+/-1.0天，58,954+/-5,238美元；TEN：16.2+/-1.0天，53,695+/-4,037美元)显著长于所有其他入院患者(4.7+/-0.02天，11,281+/-98美元)。平均调整死亡率：SJS为4.8%，SJS/TEN为19.4%，TEN为14.8%。SJS、SJS/TEN和TEN构成了很大的保健负担。死亡的预测因素包括年龄增加、慢性病增多、感染(败血症、肺炎、肺结核)、血液系统恶性肿瘤(非霍奇金淋巴瘤、白血病)和肾功能衰竭(P
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening disorders. Our study objective was to describe the incidence, costs of care, length of stay, comorbidities, and mortality of SJS and TEN in US adults. The Nationwide Inpatient Sample 2009-2012, containing a 20% sample of all US hospitalizations, was analyzed. We used a validated approach involving International Classification of Disease, 9th edition, Clinical Modification codes to identify SJS, SJS/TEN, and TEN (n = 2,591, n = 502, and n = 564, respectively). The mean estimated incidences of SJS, SJS/TEN, and TEN were 9.2, 1.6, and 1.9 per million adults per year, respectively. SJS/TEN was associated with nonwhite race, particularly Asians (odds ratio = 3.27, 95% confidence interval = 3.02-3.54) and blacks (odds ratio = 2.01, 95% confidence interval = 1.92-2.10). Significantly prolonged length of stay and higher costs of care (SJS: 9.8 +/- 0.3 days, $21,437 +/- $807; SJS/TEN: 16.5 +/- 1.0 days, $58,954 +/- $5,238; TEN: 16.2 +/- 1.0 days, $53,695 +/- $4,037) were observed compared with all other admissions (4.7 +/- 0.02 days, $11,281 +/- $98). Mean adjusted mortality was 4.8% for SJS, 19.4% for SJS/TEN, and 14.8% for TEN. SJS, SJS/TEN, and TEN pose a substantial health care burden. Predictors of mortality included increasing age, increasing number of chronic conditions, infection (septicemia, pneumonia, tuberculosis), hematological malignancy (non-Hodgkin's lymphoma, leukemia), and renal failure (P