Atrial Fibrillation and Flutter are Associated With Increased Morbidity and Mortality in Hospitalized Patients With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Document Type

Conference Proceeding

Publication Date

8-2026

Publication Title

Journal of Investigative Dermatology

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are associated with systemic inflammation and cardiovascular complications, yet acute arrhythmias, such as atrial fibrillation (AF) and atrial flutter (AFL) during hospitalization, remain poorly characterized. This study examined the association between AF/AFL and in-hospital outcomes among patients hospitalized with SJS/TEN. We performed a retrospective cohort study using the National Inpatient Sample from 2017 to 2022. Adult hospitalizations with a primary or secondary diagnosis of SJS/TEN were identified using appropriate ICD-10 codes. The exposure of interest was AF or AFL during hospitalization. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, acute kidney injury, disseminated intravascular coagulation, vasopressor use, blood transfusion, gastrointestinal bleeding, sepsis, septic shock, cerebrovascular accident, mechanical ventilation, and cardiac arrest. Multivariable logistic regression models generated adjusted odds ratios (aOR) with 95% confidence intervals. AF/AFL was associated with increased in-hospital mortality (aOR 1.65, 95% CI 1.25-2.17, p0.001). Patients with AF/AFL had higher odds of cardiogenic shock (aOR 3.16, 95% CI 1.54-6.48, p=0.002) and acute kidney injury (aOR 1.40, 95% CI 1.17-1.66, p0.001). Moreover, infectious complications were more common, including sepsis (aOR 1.42, 95% CI 1.19-1.70, p0.001) and septic shock (aOR 1.94, 95% CI 1.53-2.48, p0.001). AF/AFL was also associated with increased blood transfusions (aOR 1.85, 95% CI 1.43-2.39, p0.001) and gastrointestinal bleeding (aOR 2.00, 95% CI 1.33-3.01, p=0.001). AF/AFL is associated with substantially increased morbidity and mortality among hospitalized patients with SJS/TEN. These findings may serve as an important marker of disease severity and systemic inflammation, warranting heightened vigilance for AF/AFL in this high-risk population.

Volume

146

Issue

8 Suppl

First Page

S65

Comments

Society for Investigative Dermatology (SID) Annual Meeting, May 13-16, 2026, Chicago, IL

Last Page

S65

DOI

10.1016/j.jid.2026.06.408

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