Elevated endocan levels and its association with clinical severity in stevens johnson syndrome and toxic epidermal necrolysis Journal Article


Authors: Syed, D.; Iqbal, O; Mosier, M; Mitchell, R.; Hoppensteadt, D; Bouchard, C; Fareed, J; Gamelli, R.
Article Title: Elevated endocan levels and its association with clinical severity in stevens johnson syndrome and toxic epidermal necrolysis
Abstract: AIM: To determine the levels of endocan and other biomarkers of inflammation in the systemic circulation of three groups of patients: 1) biopsy confirmed SJS/TEN subjects; 2) patients with allergic skin reactions but biopsy negative for SJS/TEN; and 3) normal controls. To investigate the association of endocan levels with the extent of the skin lesions, the presence of purpura, and the degree of acute renal insufficiency. To investigate endocan as a marker of clinical severity by correlating endocan levels with the SCORTEN results (a prognostic score for SJS/TEN). METHODS: Sixteen patients over the age of 18 years who were referred to Loyola University Medical Center with severe allergic skin reactions were recruited over a two--year period from May 2012 to May 2014. A diagnosis of SJS or TEN was confirmed in 7 subjects by skin biopsy. Citrated plasma samples were assayed for endocan, tumor necrosis factor--alpha (TNFalpha), vascular endothelial growth factor (VEGF), and C--reactive protein (CRP). The differences between SJS/TEN subjects, biopsy negative subjects, and normal controls (n=23) were explored using ANOVA and Tukey's post--hoc test. Associations with other clinical variables were identified using linear and logistic regression. RESULTS: Biopsy positive SJS/TEN subjects and biopsy negative subjects had higher endocan levels than normal controls (SJS/TEN: 3.01 ng/mL [IQR: 2.15--8.11]; biopsy negative: 3.96 ng/mL [IQR: 1.54--4.85]; normal controls: 1.79 ng/mL [IQR: 1.67--1.98]; ANOVA p=0.0038). Endocan levels were more strongly associated with SCORTEN in SJS/TEN subjects than in biopsy negative subjects (r--squared SJS/TEN=0.5110; biopsy negative=0.0317). SJS/TEN subjects exhibited significantly higher levels of TNF--alpha compared to normal controls (p=0.0267). The TNF--alpha levels were significantly lower compared to biopsy negative subjects (p=0.0052). VEGF levels were also elevated among SJS/TEN and biopsy negative subjects compared to normal controls (SJS/TEN: 12.04 pg/mL: [IQR: 7.64--52.7]; biopsy negative: 10.54 pg/mL [IQR: 4.17--6.46]; normal controls: 4.94 pg/mL [IQR: 4.17--6.46]; ANOVA p0.0001). There was no significant difference in VEGF levels between SJS/TEN and biopsy negative subjects (p=0.7110). Similarly, CRP levels were elevated among SJS/TEN patients and biopsy negative subjects compared to normal controls (SJS/TEN: 32.09 mug/mL [IQR: 31.49--52.08]; biopsy negative: 83.38 mug/mL [IQR: 44.74--145.38]; healthy normal: 1.08 mug/mL [IQR: 0.73--2.03]; ANOVA p0.0001). There was no significant difference in CRP levels between SJS/TEN and biopsy negative subjects (p=0.2416). CONCLUSION: To our knowledge, this is the first study to evaluate enodcan, a marker of endothelial dysfunction, in the systemic circulation of SJS/TEN patients. Elevated endocan levels were more strongly associated with disease severity among SJS/TEN subjects than among less severe allergic reactions with skin involvement.
Journal Title: International angiology : a journal of the International Union of Angiology
ISSN: 1827-1839; 0392-9590
Publisher: Unknown  
Date Published: 2014
Start Page: 483
End Page: 488
Language: ENG
DOI/URL:
Notes: LR: 20141115; JID: 8402693; aheadofprint