Evaluation of prognostic indicators for necrotizing fasciitis

Abstract

Necrotizing Fasciitis (NF) is a rapid spreading lethal infection of the skin, muscles and soft tissues, with progressive inflammation along tissue planes and local destruction. The varied clinical presentation often leads to misdiagnosis. Various co-morbidities can influence the clinical course of the disease. Considering the life-threatening nature of the condition, this study is undertaken to identify significant prognostic factors, which will facilitate early diagnosis and intervention for an optimal outcome. This is a prospective study of 40 cases of Necrotizing Fasciitis, for 2 years. Maximum patients were in the age group of 51 to 70 years. 55% of patients had necrotizing fasciitis of the lower limb. Pain and fever were the commonest presenting features. 58% of patients presented with clinical features of less than 7 days duration. Trauma was the aetiological factor in 28% of patients. Diabetes Mellitus was the commonest co-morbidity (65%). E. coli was the commonest isolate in culture reports. The LRINEC Score was more than 8 in 25% of patients and less than 5 in 60% cases. Two patients required amputation, 30 underwent surgical debridement and 8 were subjected to fasciotomy. Out of the 38 cases, another 3 patients required amputation subsequently. Length of hospital stay was more than 3 weeks in 63% of cases. Mortality was noted in 12.5% of patients. The hemodynamic status of the individual at the time of presentation and during the post-operative period has a significant prognostic value. Diabetes Mellitus is a common co-morbidity existing in patients with Necrotizing Fasciitis. Other co-morbidities like hepatic and renal dysfunction, hypertension, Peripheral Vascular Disease, immune-deficient states, also affect the treatment outcome. Initial surgical debridement is of extreme importance and should be a thorough one. Early diagnosis, aggressive surgical debridement, with balanced fluid resuscitation and adequate nutritional support and a multidisciplinary approach is the key to a successful outcome.