SCORTEN: A severity-of-illness score for toxic epidermal necrolysis
SCORTEN: A severity-of-illness score for toxic epidermal necrolysis
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DOI：
10.1046/j.1523-1747.2000.00061.x
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发表时间：
2000-08-01
影响因子：
6.5
通讯作者：
Wolkenstein, P
中科院分区：
文献类型：
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作者：
Bastuji-Garin, S;Fouchard, N;Wolkenstein, P
中毒性表皮坏死松解症的死亡率约为30%。我们的目的是开发和验证一个特定的严重程度的疾病评分的情况下，中毒性表皮坏死松解症承认一个专门的单位，并比较它与简化急性生理评分和烧伤评分系统。165例患者的样本用于开发中毒性表皮坏死松解症特异性疾病严重程度评分，并评估其他评分，75例样本用于验证。模型开发使用逻辑回归方程，转化为医院死亡率的概率;验证使用校准和歧视的措施。我们确定了7个独立的死亡危险因素，并构成了中毒性表皮坏死松解症特异性疾病严重程度评分：年龄超过40岁，恶性肿瘤，心动过速超过120/min，表皮脱离的初始百分比超过10%，血清尿素超过10 mmol/L，血清葡萄糖超过14 mmol/L，碳酸氢盐低于20 mmol/L。对于每个中毒性表皮坏死松解症特异性疾病严重程度评分点，比值比为3.45（置信区间2.26-5.25）。死亡概率为：P（死亡）= e（logit）/1 + e（logit）其中logit = -4.448 +1.237（中毒性表皮坏死松解症特异性疾病严重程度评分）。校准显示预期（19.6%）和实际（20%）死亡率之间的良好一致性;接收器工作特征面积为82%的区分度也很好。简化急性生理评分和烧伤评分也与死亡率相关。区分能力较差（受试者工作特征面积：72%和75%），简化急性生理评分的校准表明预期（9.1%）和实际（26.7%）死亡率之间的一致性较差。这项研究表明，中毒性表皮坏死松解症患者的死亡风险可以准确地预测中毒性表皮坏死松解症特异性疾病严重程度评分。简化急性生理学评分和烧伤评分似乎不太充分。
The mortality of toxic epidermal necrolysis is about 30%. Our purpose was to develop and validate a specific severity-of-illness score for cases of toxic epidermal necrolysis admitted to a specialized unit and to compare it with the Simplified Acute Physiology Score and a burn scoring system. A sample of 165 patients was used to develop the toxic epidermal necrolysis-specific severity-of-illness score and evaluate the other scores, a sample of 75 for validation. Model development used logistic regression equations that were translated into probability of hospital mortality; validation used measures of calibration and discrimination. We identified seven independent risk factors for death and constituted the toxic epidermal necrolysis-specific severity-of-illness score: age above 40 y, malignancy, tachycardia above 120 per min, initial percentage of epidermal detachment above 10%, serum urea above 10 mmol per liter, serum glucose above 14 mmol per liter, and bicarbonate below 20 mmol per liter. For each toxic epidermal necrolysis-specific severity-of-illness score point the odds ratio was 3.45 (confidence interval 2.26-5.25). Probability of death was: P(death) = e(logit)/1 + e(logit) with logit = -4.448 + 1.237 (toxic epidermal nec-rolysis-specific severity-of-illness score). Calibration demonstrated excellent agreement between expected (19.6%) and actual (20%) mortality; discrimination was also excellent with a receiver operating characteristic area of 82%. The Simplified Acute Physiology Score and the burn score were also associated with mortality. The discriminatory powers were poorer (receiver operating characteristic area: 72 and 75%) and calibration of the Simplified Acute Physiology Score indicated a poor agreement between expected (9.1%) and actual (26.7%) mortality. This study demonstrates that the risk of death of toxic epidermal necrolysis patients can be accurately predicted by the toxic epidermal necrolysis-specific severity-of-illness score. The Simplified Acute Physiology Score and burn score appear to be less adequate.