Development and Validation of a Novel Score to Predict Mortality in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: CRISTEN

BACKGROUND

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening, severe mucocutaneous adverse reactions. Severity prediction at early onset is urgently required for treatment. However, previous prediction scores have been based on data of blood tests.

OBJECTIVE

This study aimed to present a novel score that predicts mortality in patients with SJS/TEN in the early stages based on only clinical information.

METHODS

We retrospectively evaluated 382 patients with SJS/TEN in a development study. A clinical risk score for TEN (CRISTEN) was created according to the association of potential risk factors with death. We calculated the sum of these risk factors using CRISTEN, and this was validated in a multinational survey of 416 patients and was compared with previous scoring systems.

RESULTS

The significant risk factors for death in SJS/TEN comprised 10 items, including patients' age of ≥65 years, ≥10% body surface area involvement, the use of antibiotics as culprit drugs, the use of systemic corticosteroid therapy before the onset, and mucosal damage affecting the ocular, buccal, and genital mucosa. Renal impairment, diabetes, cardiovascular disease, malignant neoplasm, and bacterial infection were included as underlying diseases. The CRISTEN model showed good discrimination (area under the curve [AUC] = 0.884) and calibration. In the validation study, the AUC was 0.827, which was statistically comparable to those of previous systems.

CONCLUSION

A scoring system based on only clinical information was developed to predict mortality in SJS/TEN and was validated in an independent multinational study. CRISTEN may predict individual survival probabilities and direct the management and therapy of patients with SJS/TEN.

The COVID-19 Pandemic: A Health Crisis Managed or a Panic Response with Disastrous Future Consequences?

In 1 year, COVID-19 spread rapidly worldwide affecting all societies and most age-groups. It has taken not only a toll of human lives (approaching 220 million people infected with 4.55 million reported deaths at time of writing) but also decimated every economy as countries struggle to control infection rates by introducing draconian lockdown and social distancing measures, bringing great suffering well beyond medical effects of the disease. A parallel pandemic has resulted in a deluge of information emanating from both scientific as well as international news media including social media platforms. Fact and fiction, reality, and perception have become entangled; the only realistic solution, both medically as well as politically, is concerted global vaccination (which is currently underway) to reduce further infection by introducing universal immunity. However, public controversy rages due to widespread apprehension regarding necessity, immediate risks, and long-term safety of what is perceived as "fast-tracked" medication. While some concerns may be justified, much is due to misconception and misunderstanding. This review highlights some of the issues concerning the handling of the COVID-19 crisis by governments worldwide, the medical and scientific communities, and the media and how this may have laid the foundations for a far greater medical, social, and economic burden in the coming years. We present comparative data to challenge current conceptions of this disease in the more general context of human health to provide a perspective that seems to have been lost in the general panic. We need more rational approaches to the handling of a disease which is unlikely to disappear from our spectrum of afflictions even after the magnifying glass has been removed.

Disease-related mortality among 21,609 Norwegian male military peacekeepers deployed to Lebanon between 1978 and 1998

PURPOSE

Our study assessed disease-related mortality among Norwegian male military peacekeepers deployed to Lebanon during 1978-1998.

METHODS

A total of 21,609 peacekeepers were followed from start of deployment through 2013. Standardized mortality ratios (SMRs) were calculated based on national rates for the overall cohort, by length of time since first deployment to Lebanon, and for service during high- and low-conflict periods. Poisson regression was used to determine the effect of conflict exposure.

RESULTS

In the overall cohort, a decreased risk was seen for all-cause mortality (1213 deaths, SMR = 0.85), mortality from neoplasms (SMR = 0.89), and from non-neoplastic diseases (SMR = 0.68). Disease-related mortality was lower during the first 5 years of follow-up, while mortality from external causes was elevated. After 5 years, mortality from neoplasms and external causes were similar to national rates, but mortality from non-neoplastic diseases remained lower. The high-conflict exposure group had a two-fold increased risk of mortality from non-neoplastic diseases (rate ratio = 2.33), including ischemic heart disease (rate ratio = 2.25) compared to the low-conflict exposure group.

CONCLUSIONS

We found a "healthy soldier effect" for all-cause mortality and disease-related mortality, but for neoplasms, this effect disappeared after 5 years. Conflict exposure was positively correlated with increased risk of mortality from non-neoplastic diseases.