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Charles S Bouchard, Daneyal Syed, Omer Iqbal, Michael Mosier, Ryan Mitchell, Debra Hoppensteadt, Jawed Fareed, Richard Gamelli; Elevated endocan levels and its association with clinical severity in Stevens Johnson syndrome and toxic epidermal necrolysis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3087.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the levels of endocan and inflammatory biomarkers in the systemic circulation of: 1) biopsy confirmed SJS/TEN subjects; 2) patients with allergic skin reactions but biopsy negative for SJS/TEN; and 3) healthy controls. To investigate endocan as a marker of clinical severity by correlating levels with SCORTEN.
Sixteen patients over the age of 18 years referred to Loyola University Medical Center with severe allergic skin reactions were recruited from May 2012 to May 2014. A diagnosis of SJS or TEN was confirmed in 7 subjects by skin biopsy. Citrated plasma samples were assayed for endocan, tumor necrosis factor-α (TNFα), vascular endothelial growth factor (VEGF), and C-reactive protein (CRP). Differences between SJS/TEN, biopsy negative (B-), and healthy (H) (n=23) subjects were explored using ANOVA and Tukey's post-hoc test. Associations with clinical variables were identified using linear and logistic regression. Data presented as median [IQR].
SJS/TEN and B- subjects had higher endocan levels than normal controls (SJS/TEN: 3.0ng/mL [2.2-8.1]; B-: 4.0ng/mL [1.5-4.9]; H: 1.8ng/mL [1.7-2.0]; p=0.004). Endocan levels were more strongly associated with SCORTEN in SJS/TEN subjects than in B- subjects (r-squared SJS/TEN=0.51; B-=0.03). SJS/TEN subjects exhibited significantly higher levels of TNFα compared to H subjects (p=0.03). SJS/TEN TNFα levels were significantly lower compared to B- subjects (p=0.005). VEGF levels were also elevated among SJS/TEN and B- subjects compared to H subjects (SJS/TEN: 12.0pg/mL [7.6-52.7]; B-: 10.5pg/mL [8.7-12.0]; H: 4.9pg/mL [4.2-6.5]; p<0.0005). There was no significant difference in VEGF levels between SJS/TEN and B- subjects. Similarly, CRP levels were elevated among SJS/TEN and B- compared to H subjects (SJS/TEN: 32.1µg/mL [31.5-52.1]; B-: 83.4µg/mL [44.7-145.4]; H: 1.1µg/mL [0.7-2.0; p<0.0001). There was no significant difference in CRP levels between SJS/TEN and B- subjects.
To our knowledge, this is the first study to evaluate endocan, a marker of endothelial dysfunction, in the systemic circulation of SJS/TEN patients. Elevated endocan levels were more strongly associated with disease severity among SJS/TEN subjects than among less severe allergic reactions with skin involvement.
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