The effect of comorbidities on overall mortality in Stevens- Johnson Syndrome: an analysis of the Nationwide Inpatient Sample.

BACKGROUND: Stevens Johnson Syndrome (SJS) is a life threatening skin condition with an overall mortality rate of 5%. Although the causes and pathology of the disease have been well studied, the factors that significantly contribute to mortality remain unclear.

OBJECTIVE: To determine relevant risk factors that increase the likelihood of inpatient mortality after diagnosis of SJS.

METHODS: A retrospective cohort study of the 2010-2011 Healthcare Costs and Utilization Project (HCUP) Nationwide InpatientSample (NIS) database was conducted. This study included 1,811 patients who encountered inpatient hospital stays with a discharge diagnosis of SJS.

RESULTS: The primary outcome of our study was inhospital mortality. We analyzed the prevalence and associated inpatient mortality of underlying critical illness in patients with SJS. Three age ranges of patients in this study showed significantly increased rates of inpatient mortality by odds-ratio with a 95% CI: 70-79 years (10.91% mortality, OR=4.57, p=0.001),80-89 years (10.67% mortality, OR=4.48, p=0.001), and 90+ years (9.30% mortality, OR=4.22, p=0.028). Two comorbid conditions showed significant association with increased inpatient mortality in SJS by odds-ratio with a 95% CI: cirrhosis (14.58% mortality, OR=2.79,p=0.028) and metastatic disease (10.62% mortality,OR=1.87, p=0.031).

INTERPRETATION: Age (70+ years), cirrhosis, and metastatic disease were identified as significantly associated with inpatient mortality after diagnosis with SJS. These findings enhance current understanding of the pathology of this disease, as well as help improve clinical management of high-risk patients to reduce inpatient mortality.