Supplementary Material for: Clinical Features and Prognostic Factors in Severe Cutaneous Drug Reactions

Background: Severe cutaneous adverse reactions (SCARs) include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). SJS and TEN (SJS/TEN) and DRESS are thought to be different diseases; however, they share some clinical and laboratory features. Although SCORTEN serves as an excellent prognostic marker for SJS/TEN, there is still a need for development of other prognostic markers for SCARs. Methods: The study population consisted of 88 SCAR patients. Clinical characteristics and clinical manifestations were compared between SJS/TEN and DRESS. Risk factor analyses for prolonged hospitalization were performed. Results: Of the 88 patients, 41 were SJS/TEN and 47 were DRESS. Mortality rates of TEN and DRESS were 9.8 and 2.1%, respectively. Allopurinol and carbamazepine were the most common causes of both SJS/TEN and DRESS (34.7 and 62.9%, respectively). Some of the systemic presentations, such as fever and laboratory abnormalities were common in both phenotypes. Thrombocytopenia tended to be related to prolonged hospitalization (longer than 3 weeks) in SJS/TEN (odds ratio, OR = 5.1, 95% confidence interval, CI 0.8-31.8, p = 0.076). In DRESS patients, leukocytosis at presentation (OR 4.8, 95% CI 1.1-20.3, p = 0.03) was related to prolonged hospitalization. Conclusions: Clinical features of SCARs in a tertiary hospital in Korea were similar to those reported previously. SJS/TEN and DRESS shared some clinical and laboratory features. Thrombocytopenia for SJS/TEN and leukocytosis at presentation for DRESS may be useful prognostic markers for prolonged hospitalization.背景：严重皮肤不良反应（Severe Cutaneous Adverse Reactions, SCARs）包含史蒂文斯-约翰逊综合征（Stevens-Johnson Syndrome, SJS）、中毒性表皮坏死松解症（Toxic Epidermal Necrolysis, TEN）以及嗜酸性粒细胞增多伴全身症状的药物反应（Drug Reaction with Eosinophilia and Systemic Symptoms, DRESS）。尽管SJS与TEN（合称SJS/TEN）和DRESS被视为两类不同疾病，但二者存在部分共通的临床与实验室特征。尽管SCORTEN评分（SCORTEN）可作为SJS/TEN的优良预后标志物，但目前仍需开发针对SCARs的其他预后标志物。 方法：本研究纳入88名SCARs患者，对比分析了SJS/TEN与DRESS患者的临床特征及临床表现，并针对住院时间延长开展危险因素分析。 结果：88例患者中，41例为SJS/TEN，47例为DRESS。TEN与DRESS的病死率分别为9.8%与2.1%。别嘌呤醇与卡马西平是引发SJS/TEN及DRESS的最常见致病药物，占比分别为34.7%与62.9%。发热、实验室指标异常等部分全身表现，在两种表型中均较为常见。在SJS/TEN患者中，血小板减少症倾向于与住院时间延长（超过3周）相关（比值比（odds ratio, OR）=5.1，95%置信区间（confidence interval, CI）=0.8~31.8，p=0.076）。而在DRESS患者中，就诊时的白细胞增多（比值比（odds ratio, OR）=4.8，95%置信区间（confidence interval, CI）=1.1~20.3，p=0.03）与住院时间延长存在关联。 结论：韩国某三级医院收治的SCARs患者临床特征与既往文献报道结果相似。SJS/TEN与DRESS共享部分临床及实验室特征。针对SJS/TEN的血小板减少症，以及针对DRESS的就诊时白细胞增多，或可作为预测住院时间延长的有效预后标志物。