Validation of CET score including hsCRP, Eosinophil count, Total body
surface area in patients with DRESS syndrome
Abstract
Background: Drug reaction with eosinophilia and systemic
symptoms (DRESS) is a delayed idiosyncratic severe cutaneous adverse
reaction (SCAR) which may be potentially life threatening. Recently a
simple scoring system for early screening of DRESS patients was derived
combining hsCRP levels, eosinophil count and total body surface area
(TBSA) (henceforth called CET score). The objectives of this study were
validation, lead time advantage and cost-benefits of CET score compared
to RegiSCAR scoring as gold standard. Methods:
Prospective observational case control study, wherein 110 consecutive
patients diagnosed with drug induced maculopapular exanthema during 18
months of study period were recruited. Patients were classified as cases
(DRESS) and controls (maculopapular exanthema) (MPE) using RegiSCAR
score cut off 2 (possible DRESS). They were also simultaneously screened
using CET score based on which patients were classified as positive or
negative. They were subsequently followed up on day 7 for a second
comparison and assessment of lead time and at three and six weeks for
assessment of clinical response. Results: Seventy cases
and 40 controls were recruited. At a cut-off of >2.12, the
CET score had a sensitivity of 94.29%, specificity was 60%, positive
predictive value (PPV) of 80.5%, and a negative predictive value (PPV)
of 85.7%. The median delay in diagnosing DRESS using RegiSCAR was
around 12 hours. There was a median cost benefit of 12.13 $ in favor of
CET score. Conclusions: CET score had good diagnostic
performance in screening DRESS patients with lead time of 12 hours and
fewer costs incurred.