PDF(Pubmed)
Abstract：
BACKGROUND: Necrotizing fasciitis (NF) is a critical disease with high morbidity and mortality rates that poses significant challenges in diagnosis and treatment. Prognostic factors for the clinical course of NF remain unclear and are currently under research. This study aims to identify such factors in a large cohort of patients which represents a major comprehensive investigation of prognostic factors for NF.
METHODS: Retrospective analysis was conducted on necrotizing fasciitis cases from 2003 to 2023 at two German hospitals. Data included demographics, comorbidities, laboratory findings, infection site, causative microorganisms and outcomes. Statistical analysis involved t-tests, chi-square tests, and ROC analysis.
RESULTS: A total of 209 patients were included, with a mortality rate of 18%. Patients were categorized into survivors (n = 171) and non-survivors (n = 38). Non-survivors were significantly older (68.9 ± 13.9 years vs. 55.9 ± 14.3 years; p < 0.01) and exhibited a higher prevalence of peripheral vascular diseases, cancer, and heart, liver, or renal insufficiency. Laboratory findings and scoring results also varied significantly between the two groups. The ROC curve analysis identified age as a predictor of mortality, with an optimal cut-off value of 68.5 years (sensitivity: 60.5%, specificity: 81.9%). Higher age was associated with increased mortality risk.
CONCLUSIONS: The patient\'s age stands out as the primary predictive element for mortality in necrotizing fasciitis. Additionally, we advocate for employing the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF-score), which holds substantial prognostic significance and is straightforward to calculate. Considering our findings, crafting a clinical algorithm or scoring mechanism to forecast mortality in NF would be a promising target for future research.
METHODS: Retrospective analysis was conducted on necrotizing fasciitis cases from 2003 to 2023 at two German hospitals. Data included demographics, comorbidities, laboratory findings, infection site, causative microorganisms and outcomes. Statistical analysis involved t-tests, chi-square tests, and ROC analysis.
RESULTS: A total of 209 patients were included, with a mortality rate of 18%. Patients were categorized into survivors (n = 171) and non-survivors (n = 38). Non-survivors were significantly older (68.9 ± 13.9 years vs. 55.9 ± 14.3 years; p < 0.01) and exhibited a higher prevalence of peripheral vascular diseases, cancer, and heart, liver, or renal insufficiency. Laboratory findings and scoring results also varied significantly between the two groups. The ROC curve analysis identified age as a predictor of mortality, with an optimal cut-off value of 68.5 years (sensitivity: 60.5%, specificity: 81.9%). Higher age was associated with increased mortality risk.
CONCLUSIONS: The patient\'s age stands out as the primary predictive element for mortality in necrotizing fasciitis. Additionally, we advocate for employing the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF-score), which holds substantial prognostic significance and is straightforward to calculate. Considering our findings, crafting a clinical algorithm or scoring mechanism to forecast mortality in NF would be a promising target for future research.
摘要：
背景：坏死性筋膜炎（NF）是一种具有高发病率和死亡率的危重疾病，对诊断和治疗提出了重大挑战。NF的临床过程的预后因素仍不清楚，目前正在研究中。本研究旨在在大量患者队列中确定此类因素，这代表了对NF预后因素的主要全面研究。
方法：对2003年至2023年德国两家医院的坏死性筋膜炎病例进行了回顾性分析。数据包括人口统计，合并症,实验室发现,感染部位,致病微生物和结果。统计分析涉及t检验，卡方检验,ROC分析。
结果：共纳入209例患者，死亡率为18%。患者分为幸存者（n=171）和非幸存者（n=38）。非幸存者年龄明显较大（68.9±13.9岁vs.55.9±14.3年；p<0.01），并且表现出更高的外周血管疾病患病率，癌症,和心，肝脏,或肾功能不全。实验室检查结果和评分结果在两组之间也有显著差异。ROC曲线分析确定年龄是死亡率的预测因子，最佳临界值为68.5年(灵敏度：60.5%，特异性：81.9%）。年龄增加与死亡风险增加相关。
结论：患者的年龄是坏死性筋膜炎死亡率的主要预测因素。此外,我们主张采用实验室和记忆障碍风险指标来治疗坏死性筋膜炎（LARINF评分），这具有实质性的预后意义，并且易于计算。考虑到我们的发现,制定预测NF死亡率的临床算法或评分机制将是未来研究的一个有希望的目标.
方法：对2003年至2023年德国两家医院的坏死性筋膜炎病例进行了回顾性分析。数据包括人口统计，合并症,实验室发现,感染部位,致病微生物和结果。统计分析涉及t检验，卡方检验,ROC分析。
结果：共纳入209例患者，死亡率为18%。患者分为幸存者（n=171）和非幸存者（n=38）。非幸存者年龄明显较大（68.9±13.9岁vs.55.9±14.3年；p<0.01），并且表现出更高的外周血管疾病患病率，癌症,和心，肝脏,或肾功能不全。实验室检查结果和评分结果在两组之间也有显著差异。ROC曲线分析确定年龄是死亡率的预测因子，最佳临界值为68.5年(灵敏度：60.5%，特异性：81.9%）。年龄增加与死亡风险增加相关。
结论：患者的年龄是坏死性筋膜炎死亡率的主要预测因素。此外,我们主张采用实验室和记忆障碍风险指标来治疗坏死性筋膜炎（LARINF评分），这具有实质性的预后意义，并且易于计算。考虑到我们的发现,制定预测NF死亡率的临床算法或评分机制将是未来研究的一个有希望的目标.
