Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme drug-related hospitalisations in a national administrative database

Bernardo Sousa-Pinto; Luís Araújo; Alberto Freitas; Osvaldo Correia; Luís Delgado

doi:10.1186/s13601-017-0188-1

Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme drug-related hospitalisations in a national administrative database

Clin Transl Allergy. 2018 Jan 22:8:2. doi: 10.1186/s13601-017-0188-1. eCollection 2018.

Authors

Bernardo Sousa-Pinto^{1

2

3}, Luís Araújo^{1

3

4}, Alberto Freitas^{2

3}, Osvaldo Correia^{1

3

5}, Luís Delgado^{1

3

4}

Affiliations

¹ 1Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
² 2MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal.
³ CINTESIS - Center for Health Technology and Services Research, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal.
⁴ Allergy Unit, CUF Institute, Porto, Portugal.
⁵ Epidermis Dermatology Center, CUF Institute, Porto, Portugal.

Abstract

Background: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and erythema multiforme (EM) are immunologically-mediated dermatological disorders commonly triggered by drug exposure and/or other external agents. We aimed to characterise SJS/TEN- and EM-drug-related hospitalisations in a nationwide administrative database, focusing on demographic and clinical characteristics, and in the most frequently implicated drug classes.

Methods: We analysed all drug-related hospitalisations with associated diagnosis of SJS/TEN or EM in Portuguese hospitals between 2009 and 2014. We compared gender, age, comorbidities, length of stay, and in-hospital mortality and estimated the number of episodes per million packages sold of drug classes. Predictors of in-hospital mortality were investigated in both conditions by logistic regression.

Results: There were 132 SJS/TEN-related and 122 EM-related hospitalisations. Incidence and in-hospital mortality of SJS/TEN episodes (24.2%) were consistent with previous studies. HIV co-infection was more common among SJS/TEN hospitalisations (9 vs. 2% with EM; P = 0.009). Liver disease, advanced age, and a TEN diagnosis, were significantly associated with higher risk of mortality in patients with SJS/TEN. The highest numbers of SJS/TEN and EM episodes per million drug packages sold were observed for antivirals (8.7 and 1.5, respectively), antineoplastic/immunosuppressive drugs (5.6 and 3.9, respectively) and hypouricaemic drugs (5.0 and 2.4, respectively).

Conclusions: SJS/TEN in-hospital mortality is high, and its risk factors include advanced age, liver disease, and TEN diagnosis. The drug classes most frequently associated with these conditions include antivirals, hypouricaemic drugs and antineoplastic/immunosuppressive drugs. Administrative databases seem useful in the study of SJS/TEN drug-related hospitalisations, yielding results consistent with previous studies and on a nationwide basis.

Keywords: Drug allergy; Epidemiology; Erythema multiforme; Stevens–Johnson syndrome; Toxic epidermal necrolysis.