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

Abstract

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.