AbstractIntroductionStevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap Syndrome are on the same spectrum of severe blistering skin diseases that affect the skin and mucosal surfaces of the body. They have an immunological etiology and are caused by toxins, drugs, or infectious agents. The mortality rate for patients with these conditions is high, but there is limited research on the outcomes for those patients with additional comorbidities. This study investigates the association of inflammatory conditions such as diabetes mellitus, obesity, and tobacco usage have on the outcomes of patients with SJS or related disease. It was predicted that each of these comorbidities would be associated with higher rates of mortality and disease complications.MethodsThis study is a retrospective observational cohort study using a commercially available large database, which provides deidentified electronic medical data from health care organizations all over the world. Our database was used to perform a search and analysis for patients with SJS, SJS-TEN Overlap Syndrome, and TEN as well diabetes mellitus (DM), tobacco usage (TU), or overweight/obesity status. A fourth, control cohort of patients without any comorbidities was also included. In total, 8,962 patients were included in the study: 6,348 patients in the control group; 426 patients in the TU group; 1,186 patients in the DM group, and 1,002 patients in the Obesity group. Outcome variables measured were rate and incidence of pneumonia, sepsis, and endotracheal intubation. Outcome variables from each of the four cohorts were analyzed with a total of six unique comparisons.ResultsCompared to the control group, the DM group had a mortality rate 14.3% higher (CI 95%, 11.8% -16.9%), pneumonia rate 7.6% higher (CI 95%, 5.4%-9.9%), sepsis rate 4.7% higher (CI 95%, 6.9%-11.4%), and endotracheal intubation rate of 1.9% higher (CI 95%, 0.8%-3.0%). Furthermore, compared to the Obesity group, the DM group had a mortality rate 11.6% higher (CI 95%, 8.5%- 14.8%) and sepsis rate 4.7% higher (CI 95%, 1.7%-7.6%). Compared to the TU group, the DM group had a mortality rate 12.4% higher (CI 95%, 8.5%- 16.3%) and sepsis rate 8.1% higher (CI 95% 4.7%-11.6%). Besides this data on the DM group, the Obesity group showed statistically significant worse outcomes as well. Compared to the control group, the Obesity group showed a mortality rate 2.7% higher (CI 95%, 0.5%-4.9%), pneumonia rate 5% higher (CI 95%, 2.7%-7.3%), sepsis rate 4.5% higher (CI 95%, 2.3%-6.6%), and intubation rate of 2.1% higher (CI 95%, 0.8%-3.4%).ConclusionsUsing a large multi-institutional database, Diabetes mellitus is associated with worse outcomes for patients with SJS, SJS-TEN overlaps, or TEN compared to obesity and tobacco usage.Applicability of Research to PracticeThis data argues the importance of examining a patient’s past medical history when evaluating their prognosis for SJS, SJS-TEN overlaps or TEN.