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Novel clinical risk scoring model for predicting mortality in patients with necrotizing fasciitis: The MNF scoring
Patcharin Khamnuan1, Nipaporn Chuayunan1, Acharaporn Duangjai2,3,4
1Department of Nursing, Phayao Hospital, Phayao, Thailand.
Abstract:
Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that rapidly progresses and requires urgent surgery and medical therapy. If treatment is delayed, the likelihood of an unfavorable outcome, including death, is significantly increased. The goal of this study was to develop and validate a novel scoring model for predicting mortality in patients with NF. The proposed system is hereafter referred to as the Mortality in Necrotizing Fasciitis (MNF) scoring system. A total of 1503 patients with NF were recruited from 3 provincial hospitals in Thailand during January 2009 to December 2012. Patients were randomly allocated into either the derivation cohort (n = 1192) or the validation cohort (n = 311). Clinical risk factors used to develop the MNF scoring system were determined by logistic regression. Regression coefficients were transformed into item scores, the sum of which reflected the total MNF score. The following 6 clinical predictors were included: female gender; age > 60 years; white blood cell (WBC) ≤5000/mm3; WBC ≥ 35,000/mm3; creatinine ≥ 1.6 mg/dL, and pulse rate > 130/min. Area under the receiver operating characteristic curve (AuROC) analysis showed the MNF scoring system to have moderate power for predicting mortality in patients with NF (AuROC: 76.18%) with good calibration (Hosmer-Lemeshow χ2: 1.01; P = .798). The positive likelihood ratios of mortality in patients with low-risk scores (≤2.5) and high-risk scores (≥7) were 11.30 (95% confidence interval [CI]: 6.16-20.71) and 14.71 (95%CI: 7.39-29.28), sequentially. When used to the validation cohort, the MNF scoring system presented good performance with an AuROC of 74.25%. The proposed MNF scoring system, which includes 6 commonly available and easy-to-use parameters, was shown to be an effective tool for predicting mortality in patients with NF. This validated instrument will help clinicians identify at-risk patients so that early investigations and interventions can be performed that will reduce the mortality rate among patients with NF.
Insights
A new scoring system, the Mortality in Necrotizing Fasciitis (MNF) score, effectively predicts patient mortality. This tool aids clinicians in identifying high-risk individuals for necrotizing fasciitis, enabling timely interventions and potentially reducing death rates.
Area of Science:
- Medical research
- Infectious disease epidemiology
- Clinical scoring systems
Background:
- Necrotizing fasciitis (NF) is a severe, rapidly progressing soft tissue infection with high mortality risk.
- Delayed treatment significantly increases the likelihood of poor outcomes, including death.
Purpose of the Study:
- To develop and validate a novel scoring system, the Mortality in Necrotizing Fasciitis (MNF) scoring system, for predicting mortality in NF patients.
- To provide clinicians with an effective tool for early identification of high-risk patients.
Main Methods:
- A total of 1503 NF patients were recruited and randomly allocated into derivation (n=1192) and validation (n=311) cohorts.
- Logistic regression identified six clinical predictors: female gender, age >60, WBC ≤5000/mm³, WBC ≥35,000/mm³, creatinine ≥1.6 mg/dL, and pulse rate >130/min.
- The MNF score was calculated by summing regression coefficients, and its predictive power was assessed using Area Under the Receiver Operating Characteristic Curve (AuROC) analysis.
Main Results:
- The MNF scoring system demonstrated moderate predictive power in the derivation cohort (AuROC: 76.18%) with good calibration.
- Positive likelihood ratios for mortality were 11.30 for low-risk scores and 14.71 for high-risk scores.
- The system showed good performance in the validation cohort (AuROC: 74.25%).
Conclusions:
- The validated MNF scoring system, utilizing six common clinical parameters, is an effective tool for predicting mortality in patients with necrotizing fasciitis.
- This instrument can assist clinicians in identifying at-risk patients for prompt investigation and intervention, aiming to reduce NF-related mortality.
