■如果不及时诊断和手术治疗,坏死性软组织感染(NSTIs)与显著死亡率相关。
■该研究旨在比较接受或不接受手术干预治疗的严重皮肤和软组织感染患者,并确定可以预测早期手术需求的风险因素。
■人口统计,临床,实验室,回顾性收集坏死性筋膜炎(LRINEC)的危险指标和影像学结果。
■有91例非NSTI(第1组),26例接受手术的NSTI(第2组)和8例未接受手术的可疑NSTI(第3组)。在多变量分析中,皮肤坏死,心动过速,CRP值和高血糖对手术有预测作用。性能分析显示手术使用的LRINEC评分的AUC为0.65(95CI:0.52-0.78)。将四个变量(心率,皮肤坏死,入院时CRP和血糖)为0.71(95CI:0.59-0.84)。在结果方面,第2组的中位住院时间(LOS)在统计学上较高。第1组(7天(5-15)vs.34天(20-42),p<.001)和第2组vs.第3组(34天(20-42)vs.14天(11-19)p=.005)。30天时的总住院死亡率为3.2%,三组间无统计学差异。
■尽管LRINEC评分在预测手术方面表现良好,结合四个预测变量(血糖,皮肤坏死,CRP和心率)优越。需要进一步的研究来验证该模型。
UNASSIGNED: Necrotizing soft tissue infections (NSTIs) are associated with significant mortality if not promptly diagnosed and surgically treated.
UNASSIGNED: This study aims to compare patients with severe skin and soft tissue infection treated with or without a surgical intervention and to identify risk factors that can predict the need for early surgery.
UNASSIGNED: Demographics, clinical, laboratory, Risk Indicator for Necrotizing Fasciitis (LRINEC) and imaging results were retrospectively collected.
UNASSIGNED: There were 91 non-NSTI (group 1), 26 NSTI who were operated (group 2) and eight suspected NSTI who were not operated (group 3). In the multivariate analysis, skin necrosis, tachycardia, CRP value and hyperglycemia were predictive for surgery. A performance analysis revealed AUC of 0.65 (95%CI: 0.52-0.78) as to the LRINEC score for the use of surgery. The AUC for a predictive model associating four variables (heart rate, skin necrosis, CRP and glycemia at admission) was 0.71 (95%CI: 0.59-0.84). In terms of outcome, the median length of stay (LOS) was statistically higher in group 2 vs. group 1 (seven days (5-15) vs. 34 days (20-42), p < .001) and in group 2 vs. group 3 (34 days (20-42) vs. 14 days (11-19), p = .005). The overall in-hospital mortality at 30 days was 3.2% and did not statistically differ between the three groups.
UNASSIGNED: Although the LRINEC score performed well in predicting surgery, the AUC of a model combining four predictive variables (glycemia, skin necrosis, CRP and heart rate) was superior. Further research is needed to validate this model.