Clinical value of the prognostic nutritional index and red blood cell distribution width‐to‐albumin ratio for the prediction of severity of and mortality associated with Stevens–Johnson syndrome/toxic epidermal necrolysis

• Published in: Journal of dermatology Vol. 50; no. 4; pp. 518 - 524
• Main Authors: Zhang, Zhibin, Yu, Kaihui, Jiang, Zhenyu, Liu, Ougen, Wan, Chuan, Wu, Hongxuan, Cao, Xianwei
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.04.2023
• Subjects: Albumin; Albumins; Bicarbonates; Biomarkers; Correlation analysis; Dialysis; Erythrocytes; Humans; Medical prognosis; Mortality; Nutrition Assessment; Prognosis; prognostic nutritional index; red blood cell distribution width‐to‐albumin ratio; Retrospective Studies; Risk factors; severity and mortality; Severity of Illness Index; Stevens-Johnson Syndrome - etiology; Stevens–Johnson syndrome/toxic epidermal necrolysis; Toxic epidermal necrolysis; red blood cell distribution width-to-albumin ratio; prognostic nutritional index; Stevens-Johnson syndrome/toxic epidermal necrolysis; severity and mortality
• ISSN: 0385-2407; 1346-8138
• DOI: 10.1111/1346-8138.16661

The prognostic nutritional index (PNI) and red blood cell distribution width‐to‐albumin ratio (RAR) are considered to be related to the prognosis of disease severity. However, the role of these biomarkers in predicting Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) severity and mortality is unclear. The aim of the current study was to investigate the association of PNI and RAR with severity and mortality in individuals with SJS/TEN. Clinical data were retrospectively collected from 74 individuals with SJS/TEN and 74 healthy individuals, who were matched for age and sex during the same period. PNI, RAR, and other indicators were compared between individuals with SJS/TEN and healthy controls. The association of PNI and RAR with SJS/TEN severity was assessed using Spearman or Pearson correlation analyses. Individuals with SJS/TEN were categorized into two groups, either survivors or nonsurvivors. The correlation between PNI, RAR, and SJS/TEN mortality was analyzed using univariate and multivariate logistic regression. The predictive value of the previously mentioned indicators on the mortality of patients with SJS/TEN was assessed using receiver operating characteristic curve analysis. The RAR level of patients with SJS/TEN was greater than that of the control group (p < 0.05), whereas PNI was lower. In compliance with correlation analysis, RAR was positively correlated with SCORTEN (Score of Toxic Epidermal Necrolysis) and ABCD‐10 (age, bicarbonate, cancer, dialysis, 10% body surface area) (p < 0.05), and PNI was negatively correlated (p < 0.05). RAR is a risk factor for death in patients with SJS/TEN, but an elevated PNI level is a protective factor for mortality. The best cutoff values of PNI and RAR for predicting death in patients with SJS/TEN were 31.375 (sensitivity, 84.7%; specificity, 80%) and 0.486 (sensitivity, 73.3%; specificity, 84.7%). These results underscore the potential clinical value of PNI and RAR as appropriate and meaningful biomarkers to assess the severity of SJS/TEN and the mortality associated with it.