The effect of different therapies and complete blood cell count-derived inflammatory biomarkers on the prognosis of Stevens–Johnson syndrome and toxic epidermal necrolysis

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous adverse drug reactions still with controversy in treatment. Complete blood cell count-derived inflammatory biomarkers reflect systemic inflammation, and their value in SJS/TEN has not been fully studied. OBJECTIVES: To compare the therapeutic efficacy of corticosteroid combined with adalimumab (CA), corticosteroid combined with intravenous immunoglobulin (CI) and corticosteroid monotherapy (CM), and explore prognosticators on severity and prognosis of SJS/TEN. METHODS: All inpatients with SJS/TEN treated with CA, CI or CM in two hospitals between 2015 and 2024 were studied. We calculated biomarkers, including the neutrophil/lymphocyte ratio (NLR), derived neutrophil/(leucocyte minus neutrophil) ratio (dNLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR) and neutrophil/(lymphocyte × platelet) ratio (NLPR), and analysed their correlations with severity and prognosis. RESULTS: Among 136 patients, 29 patients were treated with CA, 18 patients were treated with CI and 89 patients were treated with CM. The mortality rate in the three groups was much lower than expected based on the Severity of Illness Score for Toxic Epidermal Necrolysis (SCORTEN). The days to improvement of original lesions and days to no new lesions developing in CA and CI were significantly fewer than those in CM. NLR, dNLR, PLR and NLPR were independent risk factors for the elevation of the SCORTEN score, and MLR was an independent prognostic factor for healing time. CONCLUSIONS: The therapeutic efficacy of CA and CI is better than CM, and the incidence of complications is not increased. NLR, dNLR, PLR and NLPR may serve as potential prognosticators of severity in SJS/TEN. Higher MLR appears to be a potential poor prognostic factor for healing.