Necrotizing Fasciitis Outcomes in Diabetic vs Non-Diabetic Patients: A Systematic Review and Meta-Analysis

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection, with the lower limbs being a common site. Diabetes mellitus (DM) is a significant risk factor that influences the progression, outcome, and management of NF. Despite its clinical relevance, comparative data on diabetic versus non-diabetic NF outcomes remain limited. This study aimed to compare mortality, amputation rates, and other key outcomes between diabetic and non-diabetic patients with NF.

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Eligible studies assessed outcomes in diabetic and non-diabetic NF patients. Primary outcome measures included amputation rates, mortality, admission length, debridement frequency, and microbial growth. Secondary outcomes included the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and unplanned reoperations. Pooled analyses were performed using OpenMeta[Analyst] software, reporting odds ratios (OR) and mean differences (MD) with 95% confidence intervals.

Nine studies comprising 1,890 patients met the inclusion criteria. Diabetic patients had significantly higher rates of amputation (OR 3.77, 95% CI 3.04 to 4.68; p < 0.001) and polymicrobial infections (OR 2.53, 95% CI 1.50 to 4.26; p < 0.001). Mortality was higher among diabetic patients after sensitivity analysis (OR 1.60, 95% CI 1.09 to 2.33; p = 0.02). Length of admission did not differ significantly between groups, whereas the pooled number of debridements was marginally higher in diabetic patients (MD 0.28, 95% CI 0.05 to 0.52; p = 0.02), based on only two studies. Diabetic patients had significantly higher LRINEC scores (MD 2.02, 95% CI 1.33 to 2.72; p < 0.001).

Diabetic patients with NF experience worse clinical outcomes, including increased amputation, mortality, and polymicrobial infection. These findings highlight DM as a key prognostic factor and underscore necessity for aggressive intervention and risk stratification. Further high-quality prospective studies are needed.