SCORTEN和ABCD-10评估Stevens-Johnson综合征/中毒性表皮坏死松解症预后的比较

Comparison of the performance of SCORTEN and ABCD-10 in evaluating the prognosis of Stevens-Johnson syndrome/toxic epidermal necrolysis

目的比较中毒性表皮坏死松解症(TEN)疾病严重程度评分(SCORTEN)及ABCD-10评分系统对Stevens-Johnson综合征(SJS)/TEN患者出现死亡结局的预测评估效能。方法对2010年1月至2021年4月于四川省人民医院住院治疗的85例SJS/TEN患者的临床数据进行回顾性分析。比较SCORTEN及ABCD-10每个分数层患者的预期死亡率及实际死亡率,采用受试者操作特征(ROC)曲线及Hosmer-Lemeshow拟合优度检验评估SCORTEN及ABCD-10对死亡的预测力及校准度。结果85例患者中男37例,女48例,年龄14~88(52.36±19.31)岁,其中SJS 61例,SJS/TEN重叠6例,TEN 18例。死亡10例,病死率为11.76%。在SCORTEN和ABCD-10的危险因素中,年龄>40岁或≥50岁、入院第1天表皮剥脱>10%体表面积、心率>120次/min、血清尿素氮>10 mmol/L、血清碳酸氢盐<20 mmol/L与该组患者死亡存在统计学相关性(χ^(2)值分别为4.46、6.18、25.50、15.13、7.59、8.38,均P<0.05),而伴恶性肿瘤、血清葡萄糖水平>14 mmol/L及入院前透析与死亡无统计学相关性(χ^(2)值分别为0.35、0.10、1.38,均P>0.05)。SCORTEN和ABCD-10每个分数层患者的预期死亡率与实际死亡率差异均无统计学意义(均P>0.05)。ROC曲线显示SCORTEN及ABCD-10均对死亡有良好的预测力(曲线下面积分别为0.874、0.867,95%CI分别为0.758~0.990、0.773~0.962),但SCORTEN的模型拟合度优于ABCD-10(P值分别为0.944、0.048)。结论SCORTEN及ABCD-10评分系统均可在早期较准确地预测SJS/TEN患者的死亡概率,其中以SCORTEN校准更好,预测性能更优。

Objective To compare the performance of the severity-of-illness score for toxic epidermal necrolysis(SCORTEN)and ABCD-10(age,bicarbonate,cancer,dialysis,10%body surface area)scoring systems in predicting death in patients with Stevens-Johnson syndrome(SJS)/toxic epidermal necrolysis(TEN).Methods Clinical data were collected from 85 patients with SJS/TEN who were hospitalized in Sichuan Provincial People′s Hospital from January 2010 to April 2021,and retrospectively analyzed.The predicted mortality and actual mortality were compared at each score level of SCORTEN and ABCD-10.The receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the predictive power and calibration of SCORTEN and ABCD-10 on mortality.Results Among the 85 patients,37 were males and 48 were females,and their ages were 52.36±19.31 years(range,14-88 years).There were 61 cases of SJS,6 of SJS/TEN overlap,and 18 of TEN.Ten patients died in hospital and the fatality rate was 11.76%.Among the SCORTEN and ABCD-10 components,age>40 years or≥50 years,epidermal exfoliation>10%body surface area on the 1st day after admission,heart rate>120 beats per minute,serum urea nitrogen level>10 mmol/L and serum bicarbonate level<20 mmol/L were significantly correlated with death(χ^(2)=4.46,6.18,25.50,15.13,7.59,8.38,respectively,all P<0.05),while malignancies,serum glucose level>14 mmol/L,and pre-hospital dialysis were not significantly correlated with death(χ^(2)=0.35,0.10,1.38,respectively,all P>0.05).There were no significant differences between the predicted mortality and actual mortality at every score level of SCORTEN and ABCD-10(all P>0.05).The ROC curve showed that both SCORTEN and ABCD-10 had good predictive power for death(areas under the curve:0.874 and 0.867,95%CI:0.758-0.990,0.773-0.962,respectively),but the model goodness-of-fit of SCORTEN was superior to that of ABCD-10(P=0.944,0.048,respectively).Conclusion Both SCORTEN and ABCD-10 scoring systems could accurately predict mortality of SJS/TEN patients at early stage,but SCORTEN showed more favourable predictive power and calibration.