Predictive value of a severity-of-illness score for toxic epidermal necrolysis (SCORTEN) factors for in-hospital mortality in Stevens–Johnson syndrome/toxic epidermal necrolysis

Nikitina E. Dushkin A. Streltsov Y. Andreev S. Kruglova T. Markina U. Lebedkina M. Fedorovsky A. Karaulov A. Lysenko M. Fomina D.
2026 Frontiers Media SA

Frontiers in Medicine
2026 #12

Introduction: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions with high mortality. The A severity-of-illness score for toxic epidermal necrolysis (SCORTEN) scale remains the principal tool for early estimation of in-hospital death risk. The study was aimed to assess the predictive value of individual SCORTEN components for hospital mortality in a real-world Moscow cohort and to characterize demographic and etiologic factors associated with outcome. Methods: We retrospectively reviewed 150 adult patients (median age 50 years; IQR: 31–63; 59.3% female) admitted with SJS (45.3%) or TEN (54.7%) between 2019 and 2024. SCORTEN parameters were recorded within 24 h of admission. Univariate analyses (chi-square or Fishers exact test) identified associations between each SCORTEN variable and in-hospital death. Kaplan–Meier survival curves and Cox proportional-hazards models quantified time-to-event outcomes and adjusted hazard ratios (HR). Results: Overall mortality was 18.7% (n = 28). In univariate analysis, age >40 years (OR: 3.53; p = 0.01), associated malignancy (OR: 3.35; p = 0.03), heart rate > 120 bpm (OR: 9.42; p < 0.001), serum urea >28 mg/dL (OR: 14.25; p < 0.001), and bicarbonate <20 mmol/L (OR: 7.25; p < 0.001) were significantly linked to death. In multivariate Cox regression, malignancy (HR: 3.57; p = 0.05), urea > 28 mg/dL (HR: 4.33; p = 0.03), and tachycardia (HR: 2.77; p = 0.04) remained independent predictors. Initial epidermal detachment, serum glucose, and age did not retain significance. Discussion: These findings support continued use of SCORTEN while highlighting the need to recalibrate or augment its parameters—particularly renal and oncologic variables—to improve risk stratification in current therapeutic contexts. Copyright

clinical outcomes , in-hospital mortality (IHM) , predictive value , severity-of-illness score for toxic epidermal necrolysis (SCORTEN) , Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN)

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Moscow Center of Allergy and Immunology, Moscow Clinical Science and Research Center, Moscow, 52, Russian Federation
Department of Clinical Immunology and Allergology, The First Sechenov Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Department of General Medicine No. 1, Moscow Clinical Science and Research Center 52, Moscow, Russian Federation
Intensive Care Unit No. 9, Moscow Clinical Science and Research Center 52, Moscow, Russian Federation
Department of Clinical Pharmacology, Moscow Clinical Science and Research Center 52, Moscow, Russian Federation
Project Office, Moscow Clinical Science and Research Center 52, Moscow, Russian Federation
Faculty of Medicine, Medical Research and Educational Institute, Lomonosov Moscow State University, Moscow, Russian Federation
Life Improvement by Future Technologies (LIFT) Center, Moscow, Russian Federation
General Therapy Department, The Russian National Research Medical University Named After N.I. Pirogov, Moscow, Russian Federation
Department of Pulmonology, Astana Medical University, Astana, Kazakhstan

Moscow Center of Allergy and Immunology
Department of Clinical Immunology and Allergology
Department of General Medicine No. 1
Intensive Care Unit No. 9
Department of Clinical Pharmacology
Project Office
Faculty of Medicine
Life Improvement by Future Technologies (LIFT) Center
General Therapy Department
Department of Pulmonology

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