Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis.
This study aimed to clarify the etiologic factors predicting acute ocular progression in SJS/TEN, and identify patients who require immediate and intensive ophthalmological treatment. We previously conducted two Japanese Surveys of SJS/TEN (i.e., cases arising between 2005-2007 and between 2008-2010...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0260730 |
| _version_ | 1798023808902234112 |
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| author | Fumie Kinoshita Isao Yokota Hiroki Mieno Mayumi Ueta John Bush Shigeru Kinoshita Hirohiko Sueki Hideo Asada Eishin Morita Masanori Fukushima Chie Sotozono Satoshi Teramukai Japanese Research Committee on Severe Cutaneous Adverse Reaction |
| author_facet | Fumie Kinoshita Isao Yokota Hiroki Mieno Mayumi Ueta John Bush Shigeru Kinoshita Hirohiko Sueki Hideo Asada Eishin Morita Masanori Fukushima Chie Sotozono Satoshi Teramukai Japanese Research Committee on Severe Cutaneous Adverse Reaction |
| author_sort | Fumie Kinoshita |
| collection | DOAJ |
| description | This study aimed to clarify the etiologic factors predicting acute ocular progression in SJS/TEN, and identify patients who require immediate and intensive ophthalmological treatment. We previously conducted two Japanese Surveys of SJS/TEN (i.e., cases arising between 2005-2007 and between 2008-2010), and obtained the medical records, including detailed dermatological and ophthalmological findings, of 230 patients. Acute ocular severity was evaluated as none, mild, severe, and very severe. A multi-state model assuming the Markov process based on the Cox proportional hazards model was used to elucidate the specific factors affecting the acute ocular progression. Our findings revealed that of the total 230 patients, 23 (24%) of 97 cases that were mild at initial presentation worsened to severe/very severe. Acute ocular progression developed within 3 weeks from disease onset. Exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) and younger patient age were found to be statistically significant for the progression of ocular severity from mild to severe/very severe [hazard ratio (HR) 3.83; 95% confidence interval (CI) 1.48 to 9.91] and none to severe/very severe [HR 0.98; 95% CI 0.97 to 0.99], respectively. The acute ocular severity score at worst-condition was found to be significantly correlated with ocular sequelae. Thus, our detailed findings on acute ocular progression revealed that in 24% of SJS/TEN cases with ocular involvement, ocular severity progresses even after initiating intensive treatment, and that in younger-age patients with a history of exposure to NSAIDs, very strict attention must be given to their ophthalmological appearances. |
| first_indexed | 2024-04-11T17:52:25Z |
| format | Article |
| id | doaj.art-b3b29a4fc13145029f95a99f5a3e81fd |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-11T17:52:25Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-b3b29a4fc13145029f95a99f5a3e81fd2022-12-22T04:11:02ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-011612e026073010.1371/journal.pone.0260730Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis.Fumie KinoshitaIsao YokotaHiroki MienoMayumi UetaJohn BushShigeru KinoshitaHirohiko SuekiHideo AsadaEishin MoritaMasanori FukushimaChie SotozonoSatoshi TeramukaiJapanese Research Committee on Severe Cutaneous Adverse ReactionThis study aimed to clarify the etiologic factors predicting acute ocular progression in SJS/TEN, and identify patients who require immediate and intensive ophthalmological treatment. We previously conducted two Japanese Surveys of SJS/TEN (i.e., cases arising between 2005-2007 and between 2008-2010), and obtained the medical records, including detailed dermatological and ophthalmological findings, of 230 patients. Acute ocular severity was evaluated as none, mild, severe, and very severe. A multi-state model assuming the Markov process based on the Cox proportional hazards model was used to elucidate the specific factors affecting the acute ocular progression. Our findings revealed that of the total 230 patients, 23 (24%) of 97 cases that were mild at initial presentation worsened to severe/very severe. Acute ocular progression developed within 3 weeks from disease onset. Exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) and younger patient age were found to be statistically significant for the progression of ocular severity from mild to severe/very severe [hazard ratio (HR) 3.83; 95% confidence interval (CI) 1.48 to 9.91] and none to severe/very severe [HR 0.98; 95% CI 0.97 to 0.99], respectively. The acute ocular severity score at worst-condition was found to be significantly correlated with ocular sequelae. Thus, our detailed findings on acute ocular progression revealed that in 24% of SJS/TEN cases with ocular involvement, ocular severity progresses even after initiating intensive treatment, and that in younger-age patients with a history of exposure to NSAIDs, very strict attention must be given to their ophthalmological appearances.https://doi.org/10.1371/journal.pone.0260730 |
| spellingShingle | Fumie Kinoshita Isao Yokota Hiroki Mieno Mayumi Ueta John Bush Shigeru Kinoshita Hirohiko Sueki Hideo Asada Eishin Morita Masanori Fukushima Chie Sotozono Satoshi Teramukai Japanese Research Committee on Severe Cutaneous Adverse Reaction Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. PLoS ONE |
| title | Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. |
| title_full | Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. |
| title_fullStr | Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. |
| title_full_unstemmed | Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. |
| title_short | Multi-state model for predicting ocular progression in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. |
| title_sort | multi state model for predicting ocular progression in acute stevens johnson syndrome toxic epidermal necrolysis |
| url | https://doi.org/10.1371/journal.pone.0260730 |
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