Comorbidity-associated mortality risk in SJS/TEN: a systematic review and meta-analysis
Description
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions associated with substantial mortality, but the prognostic contribution of pre-existing comorbidities remains incompletely characterized. We systematically searched PubMed, Web of Science, and Google Scholar from inception through May 2026 for peer-reviewed studies reporting mortality and extractable comorbidity data in adults with SJS, SJS/TEN overlap, or TEN. Three reviewers independently performed study selection and data extraction, and two reviewers performed risk-of-bias assessment. Random-effects meta-analyses using restricted maximum likelihood estimation pooled odds ratios (ORs) across nine comorbidity categories; sensitivity analyses were restricted to in-hospital mortality. Thirty-nine studies comprising 69,204 patients were included. In unadjusted analyses, mortality was associated with kidney disease (OR, 3.49; 95% CI, 2.50–4.87), malignancy (OR, 3.06; 95% CI, 2.35–3.98), respiratory disease (OR, 2.79; 95% CI, 1.80–4.33), liver disease (OR, 2.34; 95% CI, 1.33–4.12), endocrine/metabolic conditions (OR, 1.88; 95% CI, 1.41–2.49), and cardiovascular disease (OR, 1.86; 95% CI, 1.47–2.36). Multivariable analyses identified malignancy (adjusted HR/OR range, 1.87–6.58), liver disease (adjusted HR/OR range, 1.81–3.10), and tuberculosis (adjusted OR, 10.12; 95% CI, 6.09–16.84) as independently associated with mortality. Findings were consistent in analyses restricted to in-hospital mortality. These comorbidities may complement established severity measures and help identify patients warranting closer monitoring, although prospective studies are needed to determine whether their incorporation improves prognostic performance.