Necrotizing Soft-Tissue Infections: A Retrospective Review of Predictive Factors for Limb Loss

Area of Science:

• Infectious Diseases
• Surgical Critical Care
• Dermatology

Background:

• Necrotizing soft-tissue infections (NSTIs) are severe conditions requiring prompt diagnosis and treatment.
• Limb loss is a significant complication of NSTIs, impacting long-term patient quality of life.
• Identifying predictors of limb loss is crucial for improving patient outcomes in NSTI management.

Purpose of the Study:

• To identify independent risk factors associated with limb loss in patients diagnosed with NSTIs.
• To analyze demographic, laboratory, and microbiological data to understand limb loss determinants.
• To provide insights for early intervention strategies to prevent limb loss.

Main Methods:

• Retrospective analysis of 49 patients with NSTIs involving upper or lower limbs from May 2003 to January 2019.
• Collected data included patient demographics, laboratory results, microbiological findings, treatments, and outcomes (limb salvage vs. limb loss).
• Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores were calculated at initial admission.

Main Results:

• The overall limb loss rate was 20.4% (10 out of 49 patients).
• Independent risk factors for limb loss included hypotension on admission (OR 8.2), LRINEC score ≥ 9 (OR 5.8), and glucose level > 300 mg/dL (OR 4.5).
• No correlation was found between specific microbiological organisms and poor outcomes like limb loss or mortality.

Conclusions:

• Hypotension at admission, elevated glucose levels (> 300 mg/dL), and high LRINEC scores (≥ 9) are significant independent predictors of limb loss in NSTI patients.
• These findings highlight the importance of early recognition and management of these risk factors.
• Prompt intervention based on these predictors may help reduce the incidence of limb loss in NSTIs.