Risk factors for sepsis and effects of pretreatment with systemic steroid therapy for underlying condition in SJS/TEN patients: Results of a nationwide cross-sectional survey in 489 Japanese patients

Yuma Sunaga, Natsumi Hama, Hirotaka Ochiai, Akatsuki Kokaze, Eun Seon Lee, Hideaki Watanabe, Michiko Kurosawa, Hiroaki Azukizawa, Hideo Asada, Yuko Watanabe, Yukie Yamaguchi, Michiko Aihara, Yoshiko Mizukawa, Manabu Ohyama, Riichiro Abe, Hideo Hashizume, Saeko Nakajima, Takashi Nomura, Kenji Kabashima, Mikiko TohyamaHayato Takahashi, Hiroki Mieno, Mayumi Ueta, Chie Sotozono, Hiroyuki Niihara, Eishin Morita, Hirohiko Sueki

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening severe cutaneous adverse reactions (SCARs). Sepsis has been shown to be the main cause of death in SJS/TEN. The European SCAR study reported that 14.8 % of SJS/TEN patients were receiving systemic steroid therapy for their underlying condition prior to onset. However, it remained unclear whether this factor affected the mortality rate. Objective: This study was performed to identify risk factors for sepsis in SJS/TEN patients. In addition, we compared patients who had and had not received systemic steroid therapy for their underlying condition. Methods: A primary survey regarding the numbers of SJS/TEN patients between 2016 and 2018 was sent to 1205 institutions in Japan. A secondary survey seeking more detailed information was sent to institutions reporting SJS/TEN patients. We analyzed 315 SJS patients and 174 TEN patients using a logistic regression model, Wilcoxon's rank-sum test, χ2 test, and Fisher's exact test. Results: Significant risk factors for sepsis included TEN, diabetes, and intensive care unit (ICU) admission. The mortality rate was significantly higher among patients with sepsis. Patients who had received systemic steroid therapy had a lower incidence of fever, and showed a higher mortality rate. Conclusion: Based on a nationwide epidemiological survey of SJS/TEN in Japan, we identified risk factors for sepsis and found that patients who had received steroid therapy for their underlying condition had a lower incidence of fever and a higher mortality rate.

Original languageEnglish
Pages (from-to)75-81
Number of pages7
JournalJournal of Dermatological Science
Volume107
Issue number2
DOIs
Publication statusPublished - 2022 Aug

Keywords

  • Corticosteroid
  • Risk factor
  • Sepsis
  • Stevens-Johnson syndrome (SJS)
  • Toxic epidermal necrolysis (TEN)

ASJC Scopus subject areas

  • Biochemistry
  • Molecular Biology
  • Dermatology

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