Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital.

Gaby Jabbour,Hassan Al-Thani,Ayman El-Menyar,Ruben Peralta,Husham Abdelrahman,Mohamed Ellabib,Nissar Shaikh,Insolvisagan Natesa Mudali

doi:10.1186/s13017-016-0097-y

Abstract

BackgroundNecrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients.MethodsA retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors).ResultsDuring a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population.ConclusionThe mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.

Highlights

Necrotizing fasciitis (NF) is a fatal aggressive infectious disease
The present study aims to determine the various predisposing and prognostic factors associated with mortality in NF patients
All consecutive patients admitted to the surgical intensive care at Hamad General Hospital (HGH) with a diagnosis of necrotizing fasciitis were retrospectively included in this analysis between January 2000 and December 2013

Summary

Introduction

Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. Necrotizing fasciitis (NF) is a rare infectious disease which is rapidly progressive and potentially fatal in nature [1]. Despite the advanced medical treatment, the rate of mortality remains as high as 24-34 %; posing a challenge for the diagnosis and management [2]. The mortality in NF patients primarily depends upon the time of the medical and surgical interventions and extent of spread of infection to the primary site (subcutaneous tissue, fasciae, skin or muscles) [3]. There are various predisposing factors for NF such as advanced age, diabetes mellitus, peripheral vascular disease, obesity, chronic renal failure and trauma [5]. Early recognition of these predisposing factors might help in the early definitive management [6]. Early surgical debridement is a known contributor to improve outcomes in NF patients [5]

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