The effect of different therapies and complete blood cell count-derived inflammatory biomarkers on the prognosis of Stevens-Johnson syndrome and toxic epidermal necrolysis

Abstract Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous adverse drug reactions still with controversy in treatment. Complete blood cell count (CBC)-derived inflammatory biomarkers reflect systemic inflammation, and their value in SJS/TEN has not been fully studied. Objective To compare the therapeutic efficacy of corticosteroid combined with adalimumab (CA), corticosteroid combined with IVIG (CI) and corticosteroid monotherapy (CM), and explore prognosticators on severity and prognosis of SJS/TEN. Methods All SJS/TEN inpatients treated with CA, CI, or CM in two hospitals between 2015 and 2024 were studied. We calculated biomarkers including neutrophil/lymphocyte ratio (NLR), derived neutrophil/(leukocyte minus neutrophil) ratio (dNLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), and neutrophil/(lymphocyte × platelet) ratio (NLPR), and analyzed their correlations with severity and prognosis. Results Among 136 patients, 29 patients were treated with CA, 18 patients were treated with CI, and 89 patients were treated with CM. The mortality rate in three groups was much lower than expected based on SCORTEN. The time to original lesions improvement and time to no new lesions developing in CA and CI were significantly shorter than those in CM. NLR, dNLR, PLR, and NLPR were independent risk factors for the elevation of SCORTEN score, and MLR was an independent prognostic factor for healing time. Conclusions The therapeutic efficacy of CA and CI is better than CM, and the incidence of complications is not increased. NLR, dNLR, PLR, and NLPR may serve as potential prognosticators of severity in SJS/TEN. Higher MLR appears to be a potential poor prognostic factor for healing.