Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study
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RESEARCH ARTICLE
Open Access
Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study Chia-Peng Chang1, Cheng-Ting Hsiao1,2, Chun-Nan Lin1 and Wen-Chih Fann1,2*
Abstract Background: Necrotizing fasciitis (NF) is a rapidly progressive infectious disease that primarily involves the fascia and subcutaneous tissue. If not promptly treated, it can lead to morbidity as well as mortality. It can affect any part of the body, most commonly the extremities. Early and aggressive surgical treatment is the proper way of management. The purpose of this study was to identify the risk factors for mortality in late amputation among NF patients that may be used in routine clinical practice to prevent mortality. Methods: A retrospective cohort study of hospitalized patients with NF was conducted in a tertiary teaching hospital in Taiwan between March 2015 and March 2018. All collected data were statistically analyzed. Results: A total of 582 patients with NF were included; 35 of them had undergone amputation (7 primary and 28 late amputations), with a 6% amputation rate. Thirteen amputated patients still died eventually (all in the late amputation group). Significant risk factors for mortality identified in the late amputation group included hemorrhagic bullae (p = 0.001, OR 4.7, 95% confidence interval (CI) 2.68–8.69), peripheral vascular disease (p < 0.001, OR 3.2, 95% CI 1.12–10.58), bacteremia (p = 0.021, OR 2.87, 95% CI 2.07–5.96), and Laboratory Risk Indicator of Necrotizing Fasciitis (LRINEC) score > 8 (p < 0.001, OR 1.97, 95% CI 1.28–4.61). Vibrio vulnificus was the main causative organism based on our study, but the microbiology results showed no significant correlation. Conclusion: NF patients with hemorrhagic bullae, comorbidity with peripheral vascular disease, presence of bacteremia, or LRINEC score > 8 should receive early and primary amputation in order to prevent mortality. Keywords: Necrotizing fasciitis, Amputation, Soft tissue infection, Risk factor, LRINEC
Background Necrotizing fasciitis (NF) is a serious form of infection involving rapidly spreading inflammation and extensive necrosis of the skin, subcutaneous tissue, and superficial fascia [1]. In order to successfully treat NF, two important factors must always be present: awareness of the disease, in spite of its rare occurrence, and consequently immediate therapy (surgical and antibiotic treatment). The treatment of choice for NF is rapid surgical debridement and broad-spectrum antibiotic therapy [2]. Delayed treatment may result in extensive loss of soft tissue associated with limb loss; moreover, the risk of mortality is * Correspondence: [email protected] 1 Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd, Puzi City, Chiayi County 613, Taiwan 2 Department of Medicine, Chang Gung University, Taoyuan, Taiwan
also increased. Even with aggressive treatment, patients may suffer significant morbidity such as amputation and organ failure [3–5]. Various predictors of mortality b
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