Analysis of the clinical characteristics and prognostic influencing factors of toxic epidermal necrolysis: A report of 52 cases

Abstract Background Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare, acute, predominantly drug-induced, life-threatening type IV hypersensitivity reaction characterized by severe skin and mucosae involvement. Objective To investigate the clinical features and explore the prognostic factors of TEN. Methods A retrospective study was conducted to select 52 TEN patients who met the inclusion criteria and were admitted to Guangdong Provincial People's Hospital from January 2008 to January 2024. The data of gender, age, admission diagnosis, department category, history of ICU or burn department treatment, cause of death, suspected allergens, comorbidities, and SCORTEN were collected. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Mann-Whitney U test. The risk factors affecting the prognosis of TEN patients were screened. Results There were 33 males(63.46%) and 19 females(36.54%), aged from 8 months to 92 years. There were 11 cases (21.15%) of epidermolysis bullosa, 10 cases (19.23%) of exfoliative dermatitis, 12 cases (23.08%) of TEN, 7 cases (13.46%) of epidermolysis bullosa, 7 cases (13.46%) of Stevens-Johnson syndrome, and 5 cases (9.62%) of severe drug eruption diagnosed on admission. The patients were admitted to 11 departments, and the mortality rate of patients with treatment history in ICU or burn department was similar to that of patients without such department treatment history (P > 0.05). All the dead patients were complicated with sepsis. The suspected pathogens of TEN patients were allopurinol (21.15%) and antibiotics (13.46%). The proportion of patients with comorbidities and the SCORTEN of patients in sepsis group were significantly higher than those in non-sepsis group (P < 0.05). The age and SCORTEN of patients in death group were significantly higher than those in survival group (P < 0.05). The SCORTEN was an independent risk factor affecting the death of TEN patients (P < 0.05). Conclusions It is difficult to diagnose TEN on admission. Male is the susceptible population and allopurinol is the most common causative agent. The proportion of patients with sepsis combined with comorbidities and SCORTEN were higher, the age of death patients was higher than that of survival patients, and the main cause of death was sepsis. The SCORTEN is an independent risk factor for mortality in TEN patients.