Management and predictors of ICU admission in DRESS: A multicentre retrospective cohort study

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare but potentially life-threatening drug-induced hypersensitivity reaction. Approximately 15% of patients require admission to an intensive care unit (ICU).

To identify factors associated with ICU admission in patients with DRESS in order to improve risk stratification and management.

We conducted a multicentre retrospective cohort study including adult patients with probable or definite DRESS (RegiSCAR score ≥4) hospitalized in Greater Paris area hospitals between July 2017 and January 2023. Data were extracted from the Assistance Publique-Hôpitaux de Paris Health Data Warehouse, covering 39 centres. The primary endpoint was DRESS-related ICU admission. Secondary endpoints included in-hospital mortality and therapeutic interventions inside and outside the ICU.

A total of 207 DRESS cases were included of whom 35 (17%) required ICU admission. Median age was 58 years [IQR 41-72], with a female predominance (62%) and a median Charlson comorbidity score of 3 [1-6]. Anti-epileptic drugs were the most frequently implicated agents (22%). Hepatic involvement was the most common visceral manifestation (70%), followed by renal (30%), haemodynamic (6.3%), cardiac (5.3%) and pulmonary involvement (1.9%). Disease severity was classified as mild in 40%, moderate in 35% and severe in 25% of cases. Nearly, all patients received corticosteroids, predominantly topical in mild to moderate forms and systemic in severe cases. Overall, in-hospital mortality was 4.8% (n = 10), rising to 20% (n = 7) among ICU patients. In multivariable analysis, hospital-acquired DRESS (adjusted odds ratio, aOR = 5.21; 95% CI [1.96; 14.1]; p = 0.001) and DRESS severity were independently associated with ICU admission (moderate forms: aOR = 3.74 [1.13; 14.9] and severe forms: aOR = 12.5 [3.79; 51.3], versus minor forms; p < 0.001).

Nearly one in five hospitalized patients with DRESS required ICU management. Hospital-acquired DRESS and disease severity were the main determinants of critical care admission, underscoring their prognostic importance.