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Performance of ABCD-10 and SCORTEN mortality prediction models in a cohort of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis

Published:April 30, 2021DOI:https://doi.org/10.1016/j.jaad.2021.04.082

      Background

      Age, bicarbonate, cancer, dialysis, 10% body surface area risk model (ABCD-10) has recently been proposed as an alternative to the SCORe of toxic epidermal necrolysis (SCORTEN) model for predicting in-hospital mortality in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). In contrast to SCORTEN, ABCD-10 incorporates prior dialysis and upweights the impact of cancer.

      Objective

      To determine the performance of ABCD-10 compared with that of SCORTEN in mortality prediction at a large, tertiary burn center.

      Methods

      A retrospective analysis of 192 patients with SJS/TEN admitted to the North Carolina Jaycee Burn Center from January 1, 2009, to December 31, 2019, was conducted. Data on these patients were collected using the burn registry and a manual chart review. The performance of both the mortality prediction models was assessed using univariate logistic regression and the Hosmer-Lemeshow test.

      Results

      The overall mortality was 22% (n = 43). Nine (5%) patients had cancer, and 7 (4%) had undergone prior dialysis; neither factor was associated with mortality (P = .11 and P = .62, respectively). SCORTEN was well calibrated to predict inpatient mortality (P = .82), whereas ABCD-10 appeared to have a poorer fit (P < .001) in these patients. Both the models showed good discrimination.

      Limitations

      Small sample size.

      Conclusion

      SCORTEN was a better predictor of inpatient mortality than ABCD-10 in a North American cohort of patients treated at the tertiary burn center.

      Key words

      Abbreviations used:

      ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area), BSA (body surface area), BUN (blood urea nitrogen), SCORTEN (SCORe for toxic epidermal necrolysis), SJS (Stevens-Johnson syndrome), TEN (toxic epidermal necrolysis)
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