Predictors of fatal outcome after severe necrotizing fasciitis: Retrospective analysis in a tertiary hospital for 20 years

Abstract

Background: Prognostic factors for fatal outcomes of patients with necrotizing fasciitis remain unclear.

Methods: We retrospectively analyzed data of patients with necrotizing fasciitis from January 1998 to July 2019 using our hospital's medical database. Clinical characteristics of patients who died during hospitalization or had been discharged were evaluated. Sex, age, body mass index, smoking history, alcohol use, comorbidities (diabetes mellitus, arteriosclerosis obliterans, heart disease, obstructive arteriosclerosis, dialysis, cancer, skin disease, steroid use history), shock vital, physical findings, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, sepsis, disseminated intravascular coagulation, fascial administration, tracheal intubation, and surgical treatment (dismemberment and/or debridement) were compared between the survivor (group S) and nonsurvivor (group N) groups.

Results: Fifty-five patients with necrotizing fasciitis were included (40 patients in group S and 15 patients in group N). Serum creatine was a significant prognostic factor (odds ratio [OR], 3.03; 95% confidence interval [CI], 0.15-0.75; P = 0.0078), with a cutoff value of 1.56 mg/dL. Moreover, the estimated glomerular filtration rate was a significant prognostic factor (OR, 1.06; 95% CI, 1.02-1.10, P = 0.000548), with a cutoff value of 20.6 mL/min.

Conclusion: Renal dysfunction is a significant prognostic factor for fatal outcomes of patients with necrotizing fasciitis.

Level of evidence: Level IV, Case series.