SCORTEN and Novel Prognostic Markers in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Systematic Review and...

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe skin reaction with high mortality, most often triggered by medications. Early identification of patients at risk is essential for guiding treatment. The SCORTEN score, comprising seven clinical and laboratory variables, is widely used to predict mortality but may have limitations across different populations. We conducted a systematic review and meta-analysis to assess SCORTEN's predictive accuracy and identify additional blood biomarkers associated with mortality in SJS/TEN. The primary aim was to evaluate the prognostic performance of individual SCORTEN parameters in adult SJS/TEN patients. The secondary aim was to explore modified SCORTEN cut-offs and identify additional laboratory biomarkers associated with mortality. We searched Medline, Embase and the Cochrane Library up to March 2024 for relevant studies. Eligible studies were assessed for quality and pooled analyses were conducted using a random-effects model. A total of 45 studies with 3467 patients were included. All seven SCORTEN variables were significantly associated with in-hospital mortality. Additionally, elevated serum creatinine, a marker of kidney function, was independently associated with increased risk of death. Other biomarkers showed potential, but data were insufficient for pooled analysis. Our results reinforce the value of SCORTEN and suggest serum creatinine may enhance risk prediction. Improved prognostication in SJS/TEN could support earlier intervention and better use of critical care resources. Further research is needed to validate new biomarkers. Trial Registration: PROSPERO registration number: CRD42022344691.