Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis

Adam M. Quinn, Kimberly Brown, Brian K. Bonish, Jonathan Curry, Kenneth B. Gordon, James Sinacore, Richard Gamelli, Brian J. Nickoloff

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30% or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM) inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN) were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273 ±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73% of patients (n=11) with sparse inflammation survived, only 47% (n=7) with moderate and 29% (n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65% using grade of inflammation, 68% with mean cell count, and 71% with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.

Original languageEnglish (US)
Pages (from-to)683-687
Number of pages5
JournalArchives of Dermatology
Volume141
Issue number6
DOIs
StatePublished - Jun 2005
Externally publishedYes

Fingerprint

Stevens-Johnson Syndrome
Inflammation
Skin
Body Surface Area
Cell Count
Burn Units
Tertiary Healthcare
Hematoxylin
Eosine Yellowish-(YS)
Bicarbonates
Drug-Related Side Effects and Adverse Reactions
Serum
Urea
Hospitalization
Nitrogen
Heart Rate
Research Personnel
Outcome Assessment (Health Care)
Clinical Trials
Biopsy

ASJC Scopus subject areas

  • Dermatology

Cite this

Quinn, A. M., Brown, K., Bonish, B. K., Curry, J., Gordon, K. B., Sinacore, J., ... Nickoloff, B. J. (2005). Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis. Archives of Dermatology, 141(6), 683-687. https://doi.org/10.1001/archderm.141.6.683

Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis. / Quinn, Adam M.; Brown, Kimberly; Bonish, Brian K.; Curry, Jonathan; Gordon, Kenneth B.; Sinacore, James; Gamelli, Richard; Nickoloff, Brian J.

In: Archives of Dermatology, Vol. 141, No. 6, 06.2005, p. 683-687.

Research output: Contribution to journalArticle

Quinn, AM, Brown, K, Bonish, BK, Curry, J, Gordon, KB, Sinacore, J, Gamelli, R & Nickoloff, BJ 2005, 'Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis', Archives of Dermatology, vol. 141, no. 6, pp. 683-687. https://doi.org/10.1001/archderm.141.6.683
Quinn, Adam M. ; Brown, Kimberly ; Bonish, Brian K. ; Curry, Jonathan ; Gordon, Kenneth B. ; Sinacore, James ; Gamelli, Richard ; Nickoloff, Brian J. / Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis. In: Archives of Dermatology. 2005 ; Vol. 141, No. 6. pp. 683-687.
@article{b3c80a461c1f4173a8565f9200a88f1f,
title = "Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis",
abstract = "Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30{\%} or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM) inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN) were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273 ±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73{\%} of patients (n=11) with sparse inflammation survived, only 47{\%} (n=7) with moderate and 29{\%} (n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65{\%} using grade of inflammation, 68{\%} with mean cell count, and 71{\%} with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.",
author = "Quinn, {Adam M.} and Kimberly Brown and Bonish, {Brian K.} and Jonathan Curry and Gordon, {Kenneth B.} and James Sinacore and Richard Gamelli and Nickoloff, {Brian J.}",
year = "2005",
month = "6",
doi = "10.1001/archderm.141.6.683",
language = "English (US)",
volume = "141",
pages = "683--687",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis

AU - Quinn, Adam M.

AU - Brown, Kimberly

AU - Bonish, Brian K.

AU - Curry, Jonathan

AU - Gordon, Kenneth B.

AU - Sinacore, James

AU - Gamelli, Richard

AU - Nickoloff, Brian J.

PY - 2005/6

Y1 - 2005/6

N2 - Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30% or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM) inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN) were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273 ±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73% of patients (n=11) with sparse inflammation survived, only 47% (n=7) with moderate and 29% (n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65% using grade of inflammation, 68% with mean cell count, and 71% with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.

AB - Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30% or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM) inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN) were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273 ±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73% of patients (n=11) with sparse inflammation survived, only 47% (n=7) with moderate and 29% (n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65% using grade of inflammation, 68% with mean cell count, and 71% with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.

UR - http://www.scopus.com/inward/record.url?scp=21844472796&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=21844472796&partnerID=8YFLogxK

U2 - 10.1001/archderm.141.6.683

DO - 10.1001/archderm.141.6.683

M3 - Article

C2 - 15967913

AN - SCOPUS:21844472796

VL - 141

SP - 683

EP - 687

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

IS - 6

ER -