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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 lifethreateningskin condition with an overall mortalityrate of 5%. Although the causes and pathologyof the disease have been well studied, the factorsthat significantly contribute to mortality remainunclear. Objective: To determine relevant risk factorsthat increase the likelihood of inpatient mortalityafter diagnosis of SJS. Methods: A retrospectivecohort study of the 2010-2011 Healthcare Costsand Utilization Project (HCUP) Nationwide InpatientSample (NIS) database was conducted. This studyincluded 1,811 patients who encountered inpatienthospital stays with a discharge diagnosis of SJS.Results: The primary outcome of our study was inhospitalmortality. We analyzed the prevalence andassociated inpatient mortality of underlying criticalillness in patients with SJS. Three age ranges ofpatients in this study showed significantly increasedrates 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), and90+ years (9.30% mortality, OR=4.22, p=0.028). Twocomorbid conditions showed significant associationwith increased inpatient mortality in SJS by odds-ratiowith 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 assignificantly associated with inpatient mortality afterdiagnosis with SJS. These findings enhance currentunderstanding of the pathology of this disease, aswell as help improve clinical management of high-riskpatients to reduce inpatient mortality.

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