Medical Technology

A Novel Biomarker Improves Epidermal Necrolysis Prognosis

NEW YORK (Reuters Health) – Among Asian adults with epidermal necrolysis, RDW/Hb (red cell distribution width to hemoglobin ratio) was strongly predictive of in-hospital mortality and bacteremia, with similar discrimination to the commonly used risk stratifier, Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN), researchers say.

When added to SCORTEN, RDW/Hb improved the predictive accuracy of the composite score, resulting in a proposed revision of SCORTEN (Re-SCORTEN).

“We were surprised and excited that RDW/hb, which is derived from the full blood count, is useful as a prognostic marker and its performance is similar to existing prognostic scores, such as SCORTEN,” Dr. Haur Yueh Lee of Singapore General Hospital told Reuters Health by email. “These findings need to be validated in other cohorts, and if similar results are shown, we can incorporate that into routine practice.”

As reported in JAMA Dermatology, the retrospective study included 192 patients with Stevens-Johnson syndrome/toxic epidermal necrolysis (median age 56; 59% women), of whom 43 (22.4%) did not survive to discharge. About a third of patients had SJS; a third had SJS/TEN overlap, and a third, TEN.

Among various novel inflammatory markers easily obtained from a complete blood count, such as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio, only RDW/hb was significant in predicting in-hospital mortality (odds ratio, 3.55) after adjustment for SCORTEN.

The RDW/Hb as applied in four risk groups (RDW/Hb <1.19; 1.20-1.38; 1.39-1.74; and >1.75) showed similar discrimination to SCORTEN (area under the curve RDW/Hb in 4 groups, 0.76 versus SCORTEN, 0.78).

When RDW/Hb was added to SCORTEN, the composite Re-SCORTEN score showed significantly better discrimination than SCORTEN alone (AUC: Re-SCORTEN, 0.83 vs. SCORTEN, 0.78).

The overall net reclassification improvement was 0.94, and the integrated discrimination improvement, 0.06.

Further, Re-SCORTEN showed good calibration based on the calibration plot.

Dr. Lee said, “Having accurate prognostic scores is vital in rare diseases such as SJS/TEN, not only because it helps to predict outcomes, but because it is also useful in evaluating treatment efficacy.”

SOURCE: JAMA Dermatology, online December 22, 2021.

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