%0 Thesis
%A Ramos del Moral, Isabel Lucila
%8 2025-06
%U https://hdl.handle.net/20.500.12880/11902
%X BACKGROUND: Cutaneous adverse reac<ons range from mild manifesta<ons to severe 
condi<ons such as Toxic Epidermal Necrolysis (TEN), with drugs causing up to 94% of the cases. 
The es<mated mortality rate for TEN is approximately 30%, with sepsis associated with 
mul<organ failure or respiratory compromise being the main causes of death. Despite this, the 
SCORTEN scale, validated for predic<ng mortality in these pa<ents, does not incorporate organ 
failure as a parameter of its evalua<on. The hypothesis stated that the presence of organ 
dysfunc<on is associated with mortality and unfavorable outcomes in pa<ents with toxic 
epidermal necrolysis. 
MATERIAL AND METHODS: An observa<onal, retrospec<ve study was conducted in pa<ents 
over 18 years diagnosed with TEN and treated in Hospital Universitario de Getafe. Clinical data 
was collected through the clinical history in HCIS and/or requested to the archive of the Hospital. 
RESULTS: Of the 84 pa<ents included, 16 died (19%), of which 2 were early deaths, and the 
remaining 14 were late deaths. The median age of the pa<ents was 50 (34.25-65). The median 
SCORTEN was 3, and the median affected skin surface (%) was 75% [Interquar<le Range (IQR)
50-90] with a mean length of stay of 13.85 days [95% Confidence Interval (CI) 6.74-26.49]
hospitalized in the Burn ICU. Significant differences were iden<fied between the age, skin surface 
area affected, APACHE II, SAPS II, SCORTEN II, and SOFA from days 0 to 4 of the survivors and
those who exhibited late mortality; in addi<on to a significantly higher presence of 
cardiovascular, respiratory, and renal failure in the laeer one. A higher incidence of infec<ons 
was also observed in pa<ents with organ failure. The ra<o (fluid input/diuresis) on day +2 in the 
ICU and arterial pH on day +1 were significantly different between pa<ents who survived and 
those who experienced late mortality, showing the highest Area Under the Receiver Opera<ng 
Characteris<c (ROC) Curve (AURC) among all variables analyzed. Addi<onally, arterial pH on day 
1 greater than 7.353 was iden<fied as the variable with the highest sensi<vity and specificity for 
discrimina<ng between survivors and pa<ents with late mortality, supported by an Odds Ra<o
(OR) of 9.646 (95% CI 2.578-34.746).
CONCLUSION: Organ failure frequently complicates the course of TEN, exhibi<ng an 
independent correla<on with mortality measurable by the SOFA scale. Mortality predic<on 
improves when considering variables like age, affected body surface area, and variables related 
to resuscita<on (ra<o fluid input/diuresis and arterial pH during resuscita<on). Adjusted 
predic<ve models, such as those considering age, affected skin surface area, APACHE II, and 
13
arterial pH on day 1, have been found to discriminate mortality more effec<vely than the 
SCORTEN method.
%T Organ dysfunction as measured by the sequential organ failure assessment score (sofa) and adverse outcomes in patients with toxic epidermal necrolysis (ten) admitied to the burn icu of the hospital universitario de getafe
%K Mortalidad
%K TEN
%K SCORTEN
%K SOFA
%K Factor predictivo
%~ END