Management and outcome of Stevens–Johnson syndrome and toxic epidermal necrolysis in patients admitted to Kenyatta National Hospital

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous drug reactions requiring intensive care and protracted hospitalization. Local data on their characteristics, management and outcomes are minimal. Our objective was to identify the complications of SJS/TEN and the management strategies employed and the effect of these on patient mortality. We conducted a retrospective cross-sectional study to determine the characteristics, management strategies and patient mortality associated with SJS/TEN in patients admitted to Kenyatta National Hospital from June 2006 to June 2016. Total population sampling was used to identify 115 patients with SJS/TEN. Data on disease complications, management strategies employed and mortality status as an outcome of therapy were extracted. Patients were predominantly managed using antimicrobials (16.4% of patients, 21.8% of whom received topical mupirocin). Fluid and electrolyte replacement, skin emolliation with liquid paraffin, temperature regulation and corticosteroids were used to treat 15.3, 13.4, 11.1 and 9.4% of patients, respectively. The mortality rate was 21.7%. Significantly (p ≤ 0.05) higher mortality was associated with patients’ area of residence, disease subclass, disease severity score, hypokalaemia, dyspnoea, haematological disturbance, sepsis and dehydration. Conversely, use of total parenteral nutrition, anticoagulants for deep venous thrombosis prophylaxis and prolonged duration of therapy were associated with significantly (p ≤ 0.001) lower mortality. Mortality was not associated with administration of corticosteroids or antibiotics. Independent predictors of mortality were hypokalaemia, dyspnoea, haematological disturbance and sepsis (all p ≤ 0.05). The main management strategy used to treat SJS/TEN was antimicrobial prophylaxis, but this was not correlated with mortality. Mortality was high and was attributed to distant patient residence, severe disease and complications, suggesting that early recognition of these signs could avert mortality.