Clinical features and prognostic factors of severe cutaneous adverse drug reactions: A single-center retrospective study of 209 cases in China.

Abstract

Severe cutaneous adverse drug reactions (SCAR) are life-threatening and contain drug reactions with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP). We aimed to evaluate clinical features and prognostic factors for SCAR patients. From January 2010 to April 2022, 209 patients with SCAR (DRESS, n=46, SJS/TEN, n=128, AGEP, n=35) were included in this study. Clinical symptoms, laboratory tests, causative drugs, disease courses, treatments, and outcomes were investigated. Antibiotics ranked first (35.9%) followed by traditional Chinese medicine (15.8%) and antiepileptic drugs (14.8%) among causative drugs of SCAR. One patient (2.2%) with DRESS and seven patients (5.5%) with SJS/TEN died in the hospital, while there was no AGEP-related mortality. The multivariate logistic regression analysis showed that high Registry of Severe Cutaneous Adverse Reactions score (OR=2.340, 95% CI=1.192-4.591) and hemoglobin<100g/L (OR=0.126, 95% CI=0.016-0.983) were independent risk factors of DRESS. Anemia (OR=0.191, 95% CI=0.037-0.984) and body surface area detached involved at day 1 (OR=2.749, 95% CI=1.115-6.778) were independent risk factors of SJS/TEN for severe acute complications and hospital death (P<0.05). Lymphocytopenia (OR=0.004, 95% CI=0.000-0.553) was a risk factor of AGEP for acute complications (P=0.028). This study reveals the clinical features and independent prognostic factors for SCAR, which may be helpful in the clinical management for SCAR patients.