Hsu, DY; Brieva, J; Silverberg, NB; Silverberg, JI
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening disorders. The study objective was to describe the incidence, costs of care, length of stay, comorbidities, and mortality of SJS and TEN in US adults. The Nationwide Inpatient Sample 2009-2012, containing a 20% sample of all US hospitalizations was analyzed. We used a validated approach involving ICD-9-CM codes to identify SJS, SJS/TEN and TEN (n=2591, 502 and 564, respectively). The mean estimated incidences of SJS, SJS/TEN and TEN were 9.2, 1.6, and 1.9 per million people per year, respectively. SJS/TEN was associated with non-white race, particularly Asians (OR [95% CI]: 3.27 [3.02-3.54]) and blacks (2.01 [1.92-2.10]). Significantly prolonged length of stay and higher costs of care (SJS: 9.8±0.3 days, $21,437±807; SJS/TEN: 16.5±1.0 days, $58,954±5,238; TEN: 16.2±1.0 days, $53,695±4,037) were observed compared to all other admissions (4.7±0.02 days, $11,281±98). Mean adjusted mortality was 4.8% for SJS, 19.4% for SJS/TEN and 14.8% for TEN. SJS, SJS/TEN, and TEN pose a substantial healthcare burden. Predictors of mortality included increasing age, increasing number of chronic conditions, infection (septicemia, pneumonia, tuberculosis), hematological malignancy (non-Hodgkin's lymphoma, leukemia) and renal failure (P≤0.03 for all). Further studies are needed to confirm mortality findings to improve prognostication of SJS/TEN.