Clinical, biochemical and serological predictors of DRESS syndrome: a prospective case-control study

J Am Acad Dermatol. 2021 Mar 27;S0190-9622(21)00634-4. doi: 10.1016/j.jaad.2021.03.075. Online ahead of print.

Abstract

Background: Although detailed scoring systems like RegiSCAR DRESS validation score are available to diagnose DRESS syndrome, a rapid and easily applicable tool to identify DRESS at presentation is lacking.

Objective: To identify the clinical, biochemical and serological markers predicting DRESS syndrome and its severity.

Methods: In this prospective observational study, 25 patients of DRESS syndrome (as cases) and 25 patients of maculopapular drug rash (as controls) were recruited, and baseline clinical, biochemical parameters along with serological markers like hsCRP, ESR and TARC levels were recorded. The ability of these clinical and laboratory parameters to identify DRESS syndrome at presentation and predict its severity was analysed.

Results: Diagnostic effectiveness of TARC level (>613.25 pg/ml), total body surface area (TBSA >35%), hsCRP (>5mg/l), eosinophils (>6%), absolute eosinophil count (>450 cells/cu.mm), aspartate transaminase (>92 U/L) were statistically similar to RegiSCAR DRESS validation score (≥ 2) for diagnosis of DRESS syndrome. Combination model (TBSA at baseline, eosinophil % and hsCRP) at cut-off of 6.8 had sensitivity of 96%, specificity of 100%. Baseline serum TARC levels did not predict DRESS severity or outcome.

Limitations: Small sample size.

Conclusion: Combination of TBSA involvement, eosinophil count and hsCRP levels can predict DRESS syndrome at presentation.

Keywords: DRESS; Drug reaction; ESR; Maculopapular drug reaction; TARC; hsCRP.