Abstract
Background: Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition caused by certain medications. Keratinocytes affected by TEN have been found to undergo apoptosis mediated by Fas-FasL interactions. Treatment with intravenous immunoglobulin (IVIG) has been proposed to inhibit this interaction. Objective: To demonstrate the effectiveness of IVIG therapy in reducing mortality in patients with TEN. Design: A retrospective analysis of 16 consecutive patients with TEN who were treated with IVIG. The SCORTEN system, a validated predictor of TEN mortality, was used to analyze the data of these patients. Using SCORTEN, we compared the predicted mortality of our patient population with observed mortality. Setting: Dermatology inpatient unit at a university-affiliated hospital. Intervention: All 16 patients received IVIG treatment daily for 4 days. Fifteen patients received 1 g/kg per day and 1 patient received 0.4 g/kg per day. Main Outcome Measures: For each patient, causes of TEN and other medical problems were documented prior to IVIG therapy, as were the 7 independent SCORTEN risk factors. Results: One patient died. Based on the SCORTEN system, 5.81 patients were expected to die. These mortality rates were compared using the standardized mortality ratio (SMR) analysis ([Σ observed deaths/Σ expected deaths] X 100) to determine the efficacy of this treatment, which showed that patients with TEN treated with IVIG were 83% less likely to die than those not treated with IVIG (SMR=0.17; 95% confidence interval, 0.0-0.96). Conclusion: Based on comparison of our observed mortality rate with the SCORTEN-predicted mortality rate, treatment with IVIG significantly decreased mortality in patients with TEN.
| Original language | English |
|---|---|
| Pages (from-to) | 39-43 |
| Number of pages | 5 |
| Journal | Archives of Dermatology |
| Volume | 139 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2003 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Dermatology
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Analysis of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis using SCORTEN : The University of Miami experience. / Trent, Jennifer T.; Kirsner, Robert; Romanelli, Paolo; Kerdel, Francisco A.
In: Archives of Dermatology, Vol. 139, No. 1, 01.01.2003, p. 39-43.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Analysis of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis using SCORTEN
T2 - The University of Miami experience
AU - Trent, Jennifer T.
AU - Kirsner, Robert
AU - Romanelli, Paolo
AU - Kerdel, Francisco A.
PY - 2003/1/1
Y1 - 2003/1/1
N2 - Background: Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition caused by certain medications. Keratinocytes affected by TEN have been found to undergo apoptosis mediated by Fas-FasL interactions. Treatment with intravenous immunoglobulin (IVIG) has been proposed to inhibit this interaction. Objective: To demonstrate the effectiveness of IVIG therapy in reducing mortality in patients with TEN. Design: A retrospective analysis of 16 consecutive patients with TEN who were treated with IVIG. The SCORTEN system, a validated predictor of TEN mortality, was used to analyze the data of these patients. Using SCORTEN, we compared the predicted mortality of our patient population with observed mortality. Setting: Dermatology inpatient unit at a university-affiliated hospital. Intervention: All 16 patients received IVIG treatment daily for 4 days. Fifteen patients received 1 g/kg per day and 1 patient received 0.4 g/kg per day. Main Outcome Measures: For each patient, causes of TEN and other medical problems were documented prior to IVIG therapy, as were the 7 independent SCORTEN risk factors. Results: One patient died. Based on the SCORTEN system, 5.81 patients were expected to die. These mortality rates were compared using the standardized mortality ratio (SMR) analysis ([Σ observed deaths/Σ expected deaths] X 100) to determine the efficacy of this treatment, which showed that patients with TEN treated with IVIG were 83% less likely to die than those not treated with IVIG (SMR=0.17; 95% confidence interval, 0.0-0.96). Conclusion: Based on comparison of our observed mortality rate with the SCORTEN-predicted mortality rate, treatment with IVIG significantly decreased mortality in patients with TEN.
AB - Background: Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition caused by certain medications. Keratinocytes affected by TEN have been found to undergo apoptosis mediated by Fas-FasL interactions. Treatment with intravenous immunoglobulin (IVIG) has been proposed to inhibit this interaction. Objective: To demonstrate the effectiveness of IVIG therapy in reducing mortality in patients with TEN. Design: A retrospective analysis of 16 consecutive patients with TEN who were treated with IVIG. The SCORTEN system, a validated predictor of TEN mortality, was used to analyze the data of these patients. Using SCORTEN, we compared the predicted mortality of our patient population with observed mortality. Setting: Dermatology inpatient unit at a university-affiliated hospital. Intervention: All 16 patients received IVIG treatment daily for 4 days. Fifteen patients received 1 g/kg per day and 1 patient received 0.4 g/kg per day. Main Outcome Measures: For each patient, causes of TEN and other medical problems were documented prior to IVIG therapy, as were the 7 independent SCORTEN risk factors. Results: One patient died. Based on the SCORTEN system, 5.81 patients were expected to die. These mortality rates were compared using the standardized mortality ratio (SMR) analysis ([Σ observed deaths/Σ expected deaths] X 100) to determine the efficacy of this treatment, which showed that patients with TEN treated with IVIG were 83% less likely to die than those not treated with IVIG (SMR=0.17; 95% confidence interval, 0.0-0.96). Conclusion: Based on comparison of our observed mortality rate with the SCORTEN-predicted mortality rate, treatment with IVIG significantly decreased mortality in patients with TEN.
UR - http://www.scopus.com/inward/record.url?scp=0037231873&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037231873&partnerID=8YFLogxK
U2 - 10.1001/archderm.139.1.39
DO - 10.1001/archderm.139.1.39
M3 - Article
C2 - 12533162
AN - SCOPUS:0037231873
VL - 139
SP - 39
EP - 43
JO - JAMA Dermatology
JF - JAMA Dermatology
SN - 2168-6068
IS - 1
ER -