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Shin-yi Chen, Wen-Hung Chung, David Ma; Factors in the Initial Presentation to Predict Subsequent Ocular Complications of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2533.
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To evaluate the severity of ocular complications of patients with Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap; and to investigate the correlation between it and clinical characteristics, hemogram, and serum chemistry data of the patients at initial presentation.
Retrospective observational case series. We review the charts of all patients admitted to Chang Gung Memorial Hospital, Taiwan, with the diagnosis of SJS, TEN and SJS/TEN overlap between 1998 and 2011. Patients who met the criteria from clinical presentation, positive skin biopsy, and received ocular exams from ophthalmologic consultations were included. Acute and chronic ocular complications were graded as mild, moderate, or severe. Chronic complication was defined as ocular manifestation after 6 months. The hemogram and serum chemistry data at admission was used.
A total 334 patients were included. Age and gender were not significantly correlated with the severity of ocular complications. The severity of acute ocular involvement was correlated with oral mucosa involvement (P=0.006), genital mucosa involvement (P=0.003), fever in the first three days (P=0.051) and the total body surface area (TBSA) of epidermal detachment (P=0.017). There was a high association between the severity of acute ocular involvement and the severity of chronic ocular complications (P<0.001). In multivariate analyses of the initial hemogram and serum chemistry data, platelet count and C-reactive protein (CRP) levels are strongly associated with chronic ocular complications (platelet count: odds ratio=0.41, P=0.001; CRP: odds ratio= 1.01, P=0.052). These two factors combined with genital mucosal involvement yield 76% predictive rate for chronic ocular complications.
The severity of acute ocular involvement is associated with oral and genital mucosal involvement, fever, and TBSA of epidermal detachment at the initial presentation. Lower platelet count and higher CRP level at admission increase the risk of subsequent chronic ocular complication.
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