Long-Term Mortality in Epidermal Necrolysis Influenced by In-Hospital Complications

Epidermal necrolysis (EN) is associated with high in-hospital and post-discharge mortality rates, with comorbidities playing a significant role in outcomes.

Researchers for the recent cohort study used French Health System data to characterize mortality and sequelae associated with EN, which includes Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The study found that EN has an incidence rate of 2.6 cases per million person-years. Among the 1,221 adult patients analyzed (median age, 66 years), in-hospital mortality was 19%, while post-discharge mortality reached 15%, resulting in an overall mortality rate of 34%.

A multivariable analysis identified several factors associated with in-hospital mortality, including increasing age (adjusted hazard ratio [AHR], 1.03 per year), a history of cancer (AHR, 2.04), dementia (AHR, 1.85), liver disease (AHR, 1.81), and severity of EN (TEN vs SJS: AHR, 2.14). Post-discharge mortality was not linked with the initial severity of EN,; however, it was influenced by comorbid conditions, including cancer, liver disease, and dementia. In-hospital complications [acute kidney injury (AHR, 2.14), and sepsis (AHR, 2.44)] also contributed to long-term mortality.

The most common sequelae observed among survivors were ophthalmologic issues and mood disorders. These findings suggest that, despite EN's rarity, it has severe long-term health impacts. Future research is recommended to better predict long-term outcomes and refine treatment strategies for patients with EN.

"The findings of this cohort study suggest that although EN is a rare condition, it is associated with high rates of in-hospital and post-discharge mortality among patients who are older and have comorbid conditions," the researchers wrote in the study. "However, in contrast with in-hospital mortality, post-discharge mortality is not associated with EN initial severity but with acute in-hospital complications (eg, acute kidney injury and sepsis). Future studies are needed to construct models to estimate long-term outcomes and sequelae in patients with EN."

Source: Bertuzzi T, et al. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.3575