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Published on: November 27, 2019
Model for End-Stage Liver Disease Is a Novel Potential Predictor of 30-Day Mortality in Patients With Necrotizing
Thilo Gambichler1,2,3, Nesrien Abou Rasched2, Laura Susok1,2
1Department of Dermatology, Klinikum Dortmund gGmbH, University Witten/Herdecke, Dortmund, Germany.
Background:
Necrotizing fasciitis (NF) is a rapidly progressive soft-tissue infection with high morbidity and mortality. Early identification of patients at risk for ICU admission and 30-day mortality is critical.
Methods:
In this multicenter cohort study, 88 NF patients were compared with age- and gender-matched erysipelas controls. We studied systemic immune-inflammation biomarkers (e.g., SII, NLR), the model for end-stage liver disease (MELD; calculated from serum bilirubin, creatinine, and INR), kidney markers, and the LRINEC score at presentation. Logistic regression identified ICU admission predictors; Cox regression assessed 30-day mortality.
Results:
Compared with erysipelas controls, NF patients had higher white-cell counts, liver enzymes, creatinine, CRP, and procalcitonin; only MELD differed among composite indices (p < 0.01). Of 88 NF cases, 58 (65.9%) required ICU care and 21 (23.9%) died within 30 days. Univariable analysis linked ICU admission to CRP > 295.3 mg/L, sepsis, trunk involvement, no upper-extremity infection, and higher LRINEC (all p < 0.01). Thirty-day mortality correlated with younger age, dementia, severe liver disease, eosinopenia, and elevated MELD, INR, and creatinine (all p < 0.05). Multivariable models showed CRP > 295.3 mg/L (OR 42.5; 95% CI 4.3-424.4) and sepsis (OR 13.5; 95% CI 3.3-32.8) as independent ICU admission predictors, and MELD score alone predicted 30-day mortality (HR 1.61 per point; 95% CI 1.13-2.30).
Conclusions:
High CRP levels confirm their value in predicting ICU admission; however, the most novel finding is the independent prognostic power of MELD for 30-day mortality. Incorporating MELD alongside CRP into clinical pathways could markedly improve early risk stratification.
