title: Prognostic value of histologic features of toxic epidermal necrolysis.
abstract: BACKGROUND
  The prognosis of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and SJS/TEN overlap syndrome has been assessed using a disease-specific severity score (SCORTEN) based on clinical and laboratory data. Histologic data may improve outcome prediction.
  
  
  OBJECTIVE
  We sought to evaluate whether dermal mononuclear infiltration and epidermal necrosis predict survival of patients with TEN, SJS, or SJS/TEN.
  
  
  METHODS
  We conducted a retrospective review of clinical records and skin biopsy specimens read without knowledge of clinical data.
  
  
  RESULTS
  We identified 108 patients (SJS, n = 42; SJS/TEN, n = 36; TEN, n = 30). Overall mortality was 21.3%. Dermal infiltration and epidermal necrosis were not associated with time from disease onset to biopsy. Extensive dermal infiltrates were seen in 19 (18.5%) patients and full-thickness epidermal necrosis in 56 (52%) patients. Dermal infiltrate severity was not associated with day-1 (D1) SCORTEN or hospital death. Epidermal necrosis severity showed trends toward associations with D1 SCORTEN (P = .11) and hospital death (P = .06). In univariate analyses, full-thickness epidermal necrosis was significantly associated with hospital death (32.1% vs 11.4%, P = .017) and worse D1 SCORTEN values (1.98 ± 1.29 vs 1.55 ± 1.21; P = .04). In the bivariate analysis, however, D1 SCORTEN remained significantly associated with hospital death (odds ratio = 3.07, 95% confidence interval 1.83-5.16) but the association with full-thickness epidermal necrosis was no longer significant (odds ratio = 2.02, 95% confidence interval 0.65-7.12).
  
  
  CONCLUSIONS
  Retrospective study design and indirect assessment of progression are limitations.
  
  
  CONCLUSIONS
  Full-thickness epidermal necrosis was associated with mortality but did not independently predict hospital death after adjustment based on the SCORTEN value. Dermal infiltrate severity was not associated with hospital death.
authors.affiliation: Department of Dermatology, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Université Paris Est, LIC EA4393, F-94010, Créteil, France. laurence.allanore@hmn.aphp.fr
authors.forename: Laurence
authors.initials: L
authors.lastname: Valeyrie-Allanore
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.forename: Sarah
authors.initials: S
authors.lastname: Guégan
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ortonne
authors.forename: Martine
authors.initials: M
authors.lastname: Bagot
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Roujeau
authors.forename: Jean E
authors.initials: JE
authors.lastname: Revuz
authors.forename: Janine
authors.initials: J
authors.lastname: Wechsler
authors.forename: Pierre
authors.initials: P
authors.lastname: Wolkenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D018450:Disease Progression; D004817:Epidermis / Q000473:pathology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000401:mortality* / Q000473:pathology