title: Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults.
abstract: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening disorders. Our study objective was to describe the incidence, costs of care, length of stay, comorbidities, and mortality of SJS and TEN in US adults. The Nationwide Inpatient Sample 2009-2012, containing a 20% sample of all US hospitalizations, was analyzed. We used a validated approach involving International Classification of Disease, 9th edition, Clinical Modification codes to identify SJS, SJS/TEN, and TEN (n = 2,591, n = 502, and n = 564, respectively). The mean estimated incidences of SJS, SJS/TEN, and TEN were 9.2, 1.6, and 1.9 per million adults per year, respectively. SJS/TEN was associated with nonwhite race, particularly Asians (odds ratio = 3.27, 95% confidence interval = 3.02-3.54) and blacks (odds ratio = 2.01, 95% confidence interval = 1.92-2.10). Significantly prolonged length of stay and higher costs of care (SJS: 9.8 ± 0.3 days, $21,437 ± $807; SJS/TEN: 16.5 ± 1.0 days, $58,954 ± $5,238; TEN: 16.2 ± 1.0 days, $53,695 ± $4,037) were observed compared with all other admissions (4.7 ± 0.02 days, $11,281 ± $98). Mean adjusted mortality was 4.8% for SJS, 19.4% for SJS/TEN, and 14.8% for TEN. SJS, SJS/TEN, and TEN pose a substantial health care burden. Predictors of mortality included increasing age, increasing number of chronic conditions, infection (septicemia, pneumonia, tuberculosis), hematological malignancy (non-Hodgkin's lymphoma, leukemia), and renal failure (P ≤ 0.03 for all). Further studies are needed to confirm mortality findings to improve prognostication of SJS/TEN.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Derek Y
authors.initials: DY
authors.lastname: Hsu
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Brieva
authors.affiliation: Department of Dermatology, Mount-Sinai Icahn School of Medicine, New York, New York, USA.
authors.forename: Nanette B
authors.initials: NB
authors.lastname: Silverberg
authors.affiliation: Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: JonathanISilverberg@gmail.com.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000191:economics / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D055815:Young Adult