{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:33:57Z","timestamp":1785227637272,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T00:00:00Z","timestamp":1685145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>At present, no predictive models are available to determine the probability of in\u2010hospital mortality rates (HMRs) in all phenotypes of severe cutaneous adverse reactions (SCARs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Our study explored whether simple clinical and laboratory assessments could help predict the HMRs in any phenotypes of SCAR patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Factors influencing HMRs in 195 adults diagnosed with different SCAR phenotypes were identified, and their optimal cut\u2010offs were determined by Youden's index. Predictive equations for HMRs for all SCAR patients and Stevens\u2010Johnson syndrome (SJS)\/toxic epidermal necrolysis (TEN) patients were determined using the exact logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Acute generalized exanthematous pustulosis (AGEP) patients were significantly older, with a short time from drug exposure to reaction, and higher neutrophil count compared to SJS\/TEN and drug reaction with eosinophilia and systemic symptoms (DRESS, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Peripheral blood eosinophilia, atypical lymphocytosis and elevated liver transaminase enzymes were significantly higher in DRESS. SJS\/TEN phenotype, age\u2009\u2265\u200971.5\u2009years, neutrophil\u2010to\u2010lymphocyte ratio\u2009\u2265\u20094.08 (high NLR) and systemic infection were factors predicting in\u2010hospital mortality in all SCAR subjects. The ALLSCAR model developed from these factors demonstrated high\u2010diagnostic accuracy for predicting HMRs in all SCAR phenotypes (area under the receiver\u2010operator curve (AUC)\u2009=\u20090.95). The risk of in\u2010hospital death was significantly increased in SCAR patients with high NLR after adjusting for systemic infection. The model derived from high NLR, systemic infection and age yielded higher accuracy than SCORTEN (AUC\u2009=\u20090.77) for predicting the HMRs in SJS\/TEN patients (AUC\u2009=\u20090.97).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Being older, having systemic infection, having a high NLR and SJS\/TEN phenotype increases ALLSCAR scores, which in turn increases the risk of in\u2010hospital mortality. These basic clinical and laboratory parameters can easily be obtained in any hospital setting. Despite its simple approach, further validation of the model is warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.19222","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T13:33:45Z","timestamp":1684762425000},"page":"1881-1890","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Key factors predicting the in\u2010hospital mortality of patients with severe cutaneous adverse reactions in Thailand"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9985-7404","authenticated-orcid":false,"given":"Nunthanach","family":"Chuenboonngarm","sequence":"first","affiliation":[{"name":"Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit Chulalongkorn University  Bangkok 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Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit Chulalongkorn University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8469-3358","authenticated-orcid":false,"given":"Bussabong","family":"Chancheewa","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit Chulalongkorn University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3272-6768","authenticated-orcid":false,"given":"Chinathip","family":"Theerawattanawit","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit Chulalongkorn University  Bangkok 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