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Serum Bicarbonate as a Marker to Predict Mortality in Toxic Epidermal Necrolysis

Background: Toxic epidermal necrolysis (TEN) is a rare life-threatening disorder characterized by extensive epidermal necrolysis. Its mortality which varies from 20% to 60% is related to risk factors such as age, extent of epidermal detachment, and base deficit. Objectives: The purpose of this study is to investigate the risk factors of mortality in our patients with TEN. Patients and methods: From the year 2000 to 2006, the patients with TEN admitted to the National Taiwan University Hospital Burn Center were studied retrospectively using chart review. Eleven potential risk factors including age, gender, underlying disease, malignancy, extent of epidermal detachment, tachycardia, serum urea, glucose, base deficit, leucopenia, and intravenous infusion of immunoglobulin (IVIG) were analyzed. Patients were grouped into survivors (n = 11) and nonsurvivors (n = 5) after intensive care treatment. Logistic regression was used in multivariate analysis for identifying important predictors of mortality. Results: The mean age of the patients with TEN was 58 years, while the mean total body surface area of epidermal necrolysis was 66.3%. The overall mortality rate was 31.3%. Among the potential risk factors, only serum bicarbonate <20 mmol/L was found to have significant association with mortality (P = .0128) in our patients with TEN. The odds of mortality in the patients with TEN having serum bicarbonate <20 mmol/L was 40 times higher than those without. Conclusion: This study has shown that serum bicarbonate <20 mmol/L is the most important risk factor of mortality in our patients with TEN and it may be used as a marker to predict hospital mortality.