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Predictors of mortality in patients with necrotizing fasciitis
Cheng-Ting Hsiao1, Hsu-Huei Weng, Yao-Dong Yuan
1Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan.
Background:
Necrotizing fasciitis is an uncommon and life-threatening soft tissue infection with high mortality. Though early aggressive surgical intervention is important for improving survival, the impact of mortality from different microorganisms remains uncertain. Our study aims to identify the association of mortality and different microorganisms, and the positive and negative predictors of mortality in patients with necrotizing fasciitis.
Methods:
This retrospective cohort study enrolled patients admitted via the emergency department (ED) with discharged diagnosis of necrotizing fasciitis (International Classification of Diseases, Ninth Revision, code 72886). Multivariate logistic regression analysis was used to identify microbiological, clinical, and biochemical variables independently associated with the mortality of necrotizing fasciitis.
Results:
Multivariate logistic regression analysis showed that Vibrio infection, Aeromonas infection, hypotension, malignancy, and band form 10% or greater were significantly associated with increase of mortality (P < .05). They were considered as positive predictors of mortality. The presence of hemorrhagic bullae, however, was significantly associated with decrease of mortality (P < .05). It was considered as negative predictor of mortality.
Conclusion:
Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell count greater than 10% are independent positive predictors of mortality in patients with necrotizing fasciitis. Streptococcal and staphylococcal infections, in contrast, are not predictors of mortality. The presence of hemorrhagic bullae is an independent negative predictor of mortality. Further study should focus on the accuracy of these factors.
Insights
Necrotizing fasciitis mortality is linked to Vibrio and Aeromonas infections, hypotension, and malignancy. Hemorrhagic bullae may indicate a better prognosis in these severe soft tissue infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Necrotizing fasciitis is a severe, life-threatening soft tissue infection with high mortality rates.
- While early surgery improves survival, the specific impact of various microorganisms on mortality is not fully understood.
- Identifying mortality predictors is crucial for effective patient management.
Purpose of the Study:
- To determine the association between different microorganisms and mortality in necrotizing fasciitis patients.
- To identify independent positive and negative predictors of mortality in this patient population.
Main Methods:
- Retrospective cohort study of patients diagnosed with necrotizing fasciitis.
- Multivariate logistic regression analysis to identify significant variables.
- Inclusion of microbiological, clinical, and biochemical data.
Main Results:
- Vibrio and Aeromonas infections, hypotension, malignancy, and elevated band forms (>10%) were positive predictors of mortality.
- Hemorrhagic bullae were identified as a negative predictor of mortality.
- Streptococcal and staphylococcal infections were not found to be predictors of mortality.
Conclusions:
- Aeromonas, Vibrio infections, cancer, hypotension, and high band forms are independent positive predictors of necrotizing fasciitis mortality.
- Hemorrhagic bullae are an independent negative predictor, suggesting a potentially better outcome.
- Further research is needed to validate the predictive accuracy of these factors.
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