Table.
Characteristics of DRESS syndrome according to people of color status
| Characteristics | White n (%) |
Patients of Color (POC) n (%)*; p-value** |
||||
|---|---|---|---|---|---|---|
| n = 173 (69) |
Blacka n = 27 (11) |
Asian n = 28 (11) |
Hispanicb n = 24 (10) |
POC n = 79 (31) |
P-value*** | |
| Female, n(%) | 107 (62) | 15 (56) | 19 (68) | 11 (46) | 45 (57) | 0.46 |
| Age, μ(SD) (years) | 55 (17) | 48 (22) | 44 (16); 0.04 | 45 (22) | 46 (20) | 0.0003 |
| Causal drugs, n(%) | ||||||
| Vancomycin | 68 (39) | 4 (15); 0.02 | 4 (14); 0.01 | 9 (38) | 17 (22) | 0.006 |
| Cephalosporin | 42 (24) | 3 (11) | 4 (14) | 4 (17) | 11 (14) | 0.06 |
| Anticonvulsantsc | 19 (11) | 9 (33); 0.005 | 4 (14) | 4 (17) | 17 (22) | 0.01 |
| TMP-SMX | 20 (12) | 1 (4) | 6 (21) | 1 (4) | 8 (10) | 0.74 |
| Allopurinol | 9 (5) | 3 (11) | 3 (11) | 0 (0) | 6 (8) | 0.46 |
| Clinical features, n(%) | ||||||
| Fever ≥ 100.6F (38 °C) | 122 (71) | 21 (78) | 15 (54) | 18 (75) | 54 (68) | 0.73 |
| Rash | 172 (99) | 27 (100) | 28 (100) | 23 (96) | 78 (99) | 0.57 |
| AEC > 500 cells/mcL | 122 (71) | 20 (74) | 20 (71) | 19 (79) | 59 (75) | 0.50 |
| Hypotension | 28 (16) | 6 (22) | 2 (7) | 0 (0); 0.03 | 8 (10) | 0.20 |
| Itching | 93 (54) | 13 (48) | 13 (46) | 9 (38) | 35 (44) | 0.16 |
| Myalgias | 11 (6) | 4 (15) | 0 (0) | 4 (17) | 8 (10) | 0.29 |
| Edema | 51 (29) | 17 (63); 0.006 | 8 (29) | 7 (29) | 32 (41) | 0.08 |
| Nausea | 30 (17) | 4 (15) | 7 (25) | 3 (13) | 14 (18) | 0.94 |
| Diarrhea | 15 (9) | 1 (4) | 4 (14) | 2 (8) | 7 (9) | 0.96 |
| Atypical lymphocytes | 41 (24) | 11 (41) | 8 (29) | 9 (38) | 28 (35) | 0.05 |
| Lymphadenopathyd | 28 (16) | 10 (37); 0.01 | 5 (18) | 5 (21) | 20 (25) | 0.09 |
| Liver injurye | 98 (57) | 21 (78); 0.04 | 19 (68) | 13 (54) | 53 (67) | 0.12 |
| Kidney injuryf | 73 (42) | 12 (44) | 4 (14); 0.005 | 9 (38) | 25 (32) | 0.11 |
| Mucosa involvement | ||||||
| Ocular mucosa | 12 (7) | 1 (4) | 0 (0) | 1 (4) | 2 (3) | 0.15 |
| Oral mucosa | 21 (12) | 3 (11) | 6 (21) | 3 (13) | 12 (15) | 0.5 |
| Genital mucosa | 8 (5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0.05 |
| Rash morphology | ||||||
| Erythematous | 126 (73) | 15 (56) | 19 (68) | 14 (58) | 48 (61) | 0.05 |
| Morbilliform | 101 (58) | 13 (48) | 14 (50) | 15 (63) | 42 (53) | 0.52 |
| Macules | 29 (17) | 5 (19) | 6 (21) | 8 (33) | 19 (24) | 0.17 |
| Urticarial | 11 (6) | 3 (11) | 2 (7) | 1 (4) | 6 (8) | 0.93 |
| Bullous | 5 (3) | 1 (4) | 0 (0) | 1 (4) | 2 (3) | 0.87 |
| Pustular | 0 (0) | 1 (4); 0.01 | 2 (7); 0.02 | 0 (0) | 3 (4) | 0.01 |
| Rash descriptors | ||||||
| Erythema | 31 (18) | 6 (22) | 5 (18) | 2 (8); 0.24 | 13 (16); 0.78 | 0.78 |
| Dusky | 1 (1) | 3 (11); 0.0008 | 3 (11); 0.009 | 2 (8); 0.04 | 8 (10) | 0.0002 |
| Treatment, n(%) | ||||||
| Systemic steroids | 133 (77) | 20 (74) | 23 (82) | 18 (75) | 61 (77) | 0.95 |
| Topical steroids | 87 (50) | 16 (59) | 18 (64) | 12 (50) | 46 (58) | 0.24 |
| Antihistamine | 71 (41) | 11 (41) | 14 (50) | 8 (33) | 33 (42) | 0.91 |
| Cyclosporine | 6 (3) | 2 (7) | 2 (7) | 2 (8) | 6 (8) | 0.15 |
| IVIG | 1 (1) | 0 (0) | 1 (4) | 1 (4) | 2 (3) | 0.18 |
| Epinephrine | 2 (1) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0.33 |
| RegiSCAR, n(%) | ||||||
| >5 | 34 (20) | 9 (33) | 5 (18) | 4 (17) | 18 (23) | 0.69 |
| 4–5 | 57 (33) | 9 (33) | 7 (25) | 7 (29) | 23 (29) | 0.64 |
| 2–3 | 44 (25) | 6 (22) | 7 (25) | 8 (33) | 21 (27) | 0.97 |
| <2 | 38 (22) | 3 (11) | 9 (32) | 5 (21) | 17 (21) | 0.93 |
| Suspected causal drug withdrawal, μ days (SD)g | −0.5 (7.8) | 3.1 (10.6); 0.04 | 2.2 (5.9) | 1.3 (6.3) | 2.2 (7.9); 0.01 | 0.01 |
| Time to systemic steroid, μ days (SD) | 6.9 (9.6) | 6.2 (6.2) | 8.7 (6.1) | 7.2 (7.2) | 7.4 (6.5) | 0.67 |
| Length of Stay, μ days (SD)h | 19 (23.5) | 14 (16.5) | 21 (21.0) | 25 (22.8) | 19 (20.6) | 0.91 |
| Resolution, μ days (SD) | 31 (42) | 25 (22) | 41 (37) | 19 (15); 0.04 | 29 (28) | 0.75 |
| Hospital mortality, n(%) | 5 (3) | 1 (4) | 1 (4) | 2 (8) | 4 (5) | 0.62 |
Percentage is the prevalence for non-continuous characteristics among each subgroup; columns may add up to greater than 100%.
Significant p-values (<0.05) comparing specific race or ethnicity to white, non-Hispanic patients.
P values compare people of color to the reference group (white, non-Hispanic).
Patients who identified their race as Black and ethnicity as Hispanic (n=2) or as non-Hispanic (n=20) were considered Black.
Patients who identified their ethnicity as Hispanic and race as white (n=4), other (n=6), or unknown (n=4) were considered Hispanic.
Carbamazepine (white, n=1; Asian n=2), lamotrigine (white, n=12; Black, n=3; Asian, n=1; Hispanic, n=4), levetiracetam (white, n=1; Black, n=1), phenytoin (white, n=4; Black, n=5; Asian, n=1), sodium valproate (white, n=1).
Lymphadenopathy was defined as having at least two sites with lymph nodes 1 cm or greater.
Liver Injury was defined as alanine transaminase ≥ 100 U/L.
Kidney injury is a creatinine increase by 0.5 mg/dL or 50% above baseline.
Time to suspected causal drug withdrawal was defined as the number of days between the start of the first symptom of DRESS and the withdrawal of the suspected offending drug.
Length of stay was calculated as the number of days between the admission date and discharge date.
Abbreviations: TMP-SMX, trimethoprim-sulfamethoxazole; AEC, absolute eosinophil count; IVIG, intravenous immune globulin; RegiSCAR, European registry on severe cutaneous adverse drug reactions; LOS,