Predictive value of a severity-of-illness score for toxic epidermal necrolysis (SCORTEN) factors for in-hospital mortality in Stevens-Johnson syndrome/toxic epidermal necrolysis.

INTRODUCTION

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions with high mortality. The A severity-of-illness score for toxic epidermal necrolysis (SCORTEN) scale remains the principal tool for early estimation of in-hospital death risk. The study was aimed to assess the predictive value of individual SCORTEN components for hospital mortality in a real-world Moscow cohort and to characterize demographic and etiologic factors associated with outcome.

METHODS

We retrospectively reviewed 150 adult patients (median age 50 years; IQR: 31-63; 59.3% female) admitted with SJS (45.3%) or TEN (54.7%) between 2019 and 2024. SCORTEN parameters were recorded within 24 h of admission. Univariate analyses (chi-square or Fisher's exact test) identified associations between each SCORTEN variable and in-hospital death. Kaplan-Meier survival curves and Cox proportional-hazards models quantified time-to-event outcomes and adjusted hazard ratios (HR).

RESULTS

Overall mortality was 18.7% (n = 28). In univariate analysis, age >40 years (OR: 3.53; p = 0.01), associated malignancy (OR: 3.35; p = 0.03), heart rate > 120 bpm (OR: 9.42; p < 0.001), serum urea >28 mg/dL (OR: 14.25; p < 0.001), and bicarbonate <20 mmol/L (OR: 7.25; p < 0.001) were significantly linked to death. In multivariate Cox regression, malignancy (HR: 3.57; p = 0.05), urea > 28 mg/dL (HR: 4.33; p = 0.03), and tachycardia (HR: 2.77; p = 0.04) remained independent predictors. Initial epidermal detachment, serum glucose, and age did not retain significance.

DISCUSSION: These findings support continued use of SCORTEN while highlighting the need to recalibrate or augment its parameters-particularly renal and oncologic variables-to improve risk stratification in current therapeutic contexts.