A novel prognostic model predicts severe cutaneous adverse reaction mortality

Standard blood tests can help physicians predict the risk of mortality in patients with drug reaction with eosinophilia and systemic symptoms (DRESS), a rare but potentially life-threatening reaction to certain medications. Due to its severity, early recognition and risk assessment are critical.

In contrast to other severe drug reactions—such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)—for which several prognostic models exist, there are still limited tools to predict the clinical course of DRESS. Moreover, few proposed markers of DRESS rely on specialized laboratory tests that may not be available in all health care settings.

Professor Chia-Yu Chu’s team explored whether common blood tests could help fill this gap. The researchers focused on novel inflammatory markers—such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW)—which are readily obtained from a standard complete blood count.

These markers are commonly used to reflect the body’s inflammatory status and have been suggested to have prognostic value in various diseases. Since DRESS involves immune system dysregulation and inflammation, the team hypothesized that the blood markers might provide valuable insights into a patient’s risk of poor outcomes.

The study, published in the Journal of the American Academy of Dermatology, enrolled a cohort of Asian patients diagnosed with DRESS from hospitals in Taiwan, Singapore, and Japan. The researchers analyzed their blood test results taken within three days of diagnosis, looking for patterns that distinguished patients who survived from those who did not.

They found that several of these basic blood measures were indeed significant predictors of mortality. Specifically, a lower hemoglobin-to-RDW ratio (HRR), a higher PLR, and a lower monocyte count were associated with an increased risk of death.

Based on these findings, the team developed a prognostic model incorporating these inflammatory markers alongside underlying comorbidities. The model demonstrated good accuracy in predicting mortality, with internal validation confirming its reliability.

These easily obtainable markers offer a practical tool for clinicians, enabling early identification of high-risk DRESS patients who may benefit from intensified treatment or closer monitoring. This represents an important step toward more personalized and timely care in the management of DRESS.

Tyng-Shiuan Hsieh, a dermatologist at National Taiwan University Hospital and the first author of the study, said, “We’ve long been searching for better ways to stratify risk in patients with DRESS. Our findings demonstrate that by combining information on patients’ underlying conditions with routine blood tests, we can develop a prognostic model to predict mortality in DRESS.”

Professor Chia-Yu Chu, head of the Department of Dermatology at National Taiwan University Hospital and the study’s corresponding author, added, “This approach enables more accurate risk stratification in DRESS patients, paving the way for tailored treatment strategies based on individual risk profiles.”

These findings may facilitate earlier interventions and enable more personalized treatment strategies for this severe cutaneous adverse reaction (SCAR).