Materiały źródłowe

• #1 Triple diagnostics for early detection of ambivalent necrotizing fasciitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-016-0108-z

  Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. […] The disease can be rapidly progressive and can have devastating outcome with many patients not surviving the infection (up to 70 % mortality rate reported in past series). […] Over the last decade, mortality rate has decreased to 20-40 % in reported series. […] In the present series 55 % suffered severe co-morbidities such as congestive heart failure, renal insufficiency or acute leukemia. […] Mortality due to necrotizing fasciitis was the outcome in two patients (12.5 %) and 2 additional patients died within the first 30 days after admission due to other pre-existing conditions (25 % total 30 day mortality). […] Mortality due to necrotizing fasciitis in this series was 12.5 % and overall mortality was 25 %, which is a fair result considering the large number of ASA IV classified patients.

• #2 Triple diagnostics for early detection of ambivalent necrotizing fasciitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-016-0108-z

  Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. […] The disease can be rapidly progressive and can have devastating outcome with many patients not surviving the infection (up to 70 % mortality rate reported in past series). […] Over the last decade, mortality rate has decreased to 20-40 % in reported series. […] In the present series 55 % suffered severe co-morbidities such as congestive heart failure, renal insufficiency or acute leukemia. […] Mortality due to necrotizing fasciitis was the outcome in two patients (12.5 %) and 2 additional patients died within the first 30 days after admission due to other pre-existing conditions (25 % total 30 day mortality). […] Mortality due to necrotizing fasciitis in this series was 12.5 % and overall mortality was 25 %, which is a fair result considering the large number of ASA IV classified patients.

• #3 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The reported mortality in patients with necrotizing fasciitis has ranged from 20% to as high as 80%. […] Poor prognosis in necrotizing fasciitis has been linked to infection with certain streptococcal strains. […] A retrospective study by Hsiao et al found that Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell (WBC) count greater than 10% were independent positive predictors of mortality in patients with necrotizing fasciitis, while streptococcal and staphylococcal infections were not identified as predictors of mortality. […] A retrospective study by Illg et al indicated that necrotizing fasciitis tends to be more severe in persons categorized as overweight. […] A retrospective study by Momtaz et al indicated that in persons with necrotizing fasciitis, the amputation rate is greater in those with lower socioeconomic status (SES).

• #4 Triple diagnostics for early detection of ambivalent necrotizing fasciitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-016-0108-z

  Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. […] The disease can be rapidly progressive and can have devastating outcome with many patients not surviving the infection (up to 70 % mortality rate reported in past series). […] Over the last decade, mortality rate has decreased to 20-40 % in reported series. […] In the present series 55 % suffered severe co-morbidities such as congestive heart failure, renal insufficiency or acute leukemia. […] Mortality due to necrotizing fasciitis was the outcome in two patients (12.5 %) and 2 additional patients died within the first 30 days after admission due to other pre-existing conditions (25 % total 30 day mortality). […] Mortality due to necrotizing fasciitis in this series was 12.5 % and overall mortality was 25 %, which is a fair result considering the large number of ASA IV classified patients.

• #5 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  If you have this condition, your best outcome will come from receiving an accurate diagnosis and quick treatment with antibiotics combined with surgery to remove the dead tissue. […] Necrotizing fasciitis (flesh-eating disease) gets worse quickly, destroying your tissue and causing things like organ failure. Even with treatment, 1 out of 3 people dies from this disease. […] You may need more than one surgery to manage necrotizing fasciitis. You may have scarring.

• #6 Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

  https://www.mdpi.com/2036-7449/16/3/35

  The age of the patient is the most important prognostic factor 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. […] 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. […] Our study showed an overall mortality rate of 18%, which is in line with the existing literature (12%; 22% and 32%) that also examined prognostic factors for NF and found an overall mortality rate. […] The statistically significant prognostic value of the LARINF score (p = 0.02) also appears plausible, as it adds a number of clinical indicators (such as heart/liver/renal insufficiency/obesity and immunosuppression) to the laboratory indicators, which, when evaluated individually in other studies (>2 comorbidities), also yielded significant prognostic values. […] Our findings suggest that approximately one-quarter of patients admitted to an intensive care unit with a diagnosis of necrotizing fasciitis do not survive.

• #7

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age 60 years, elevated creatinine, abnormal blood platelets, and group A -hemolytic Streptococcus (GABS) infection. […] Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age 60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality. […] Of the 340 patients in this study, 43 died in hospital (12.7%). The deceased cohort was significantly older (P .05). Survivors had a significantly higher rate of wound closure via graft, free tissue transfer, or other closure compared to the deceased cohort (P .05). The deceased cohort also had a higher rate of ICU admission, more days in ICU, and received more packed red blood cells (P .05).

• #8 Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

  https://www.mdpi.com/2036-7449/16/3/35

  The age of the patient is the most important prognostic factor 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. […] 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. […] Our study showed an overall mortality rate of 18%, which is in line with the existing literature (12%; 22% and 32%) that also examined prognostic factors for NF and found an overall mortality rate. […] The statistically significant prognostic value of the LARINF score (p = 0.02) also appears plausible, as it adds a number of clinical indicators (such as heart/liver/renal insufficiency/obesity and immunosuppression) to the laboratory indicators, which, when evaluated individually in other studies (>2 comorbidities), also yielded significant prognostic values. […] Our findings suggest that approximately one-quarter of patients admitted to an intensive care unit with a diagnosis of necrotizing fasciitis do not survive.

• #9

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age 60 years, elevated creatinine, abnormal blood platelets, and group A -hemolytic Streptococcus (GABS) infection. […] Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age 60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality. […] Of the 340 patients in this study, 43 died in hospital (12.7%). The deceased cohort was significantly older (P .05). Survivors had a significantly higher rate of wound closure via graft, free tissue transfer, or other closure compared to the deceased cohort (P .05). The deceased cohort also had a higher rate of ICU admission, more days in ICU, and received more packed red blood cells (P .05).

• #10

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  Necrotizing fasciitis (NF) is a severe soft tissue infection with a high morbidity and mortality. With early diagnosis and treatment this could be reduced. […] In this study, we search for prognostic factors for mortality in necrotizing fasciitis. […] The overall mortality was 31.7% (N=39). […] Patients who died as the result of NF had a significantly higher median LRINEC score (8 vs. 7, p=0.034). Other parameters found to be associated with mortality are age≥60 years, cardiovascular disease in the medical history, 2 comorbidities, and lactate level greater than 1.7 mmol/L. […] LRINEC score should be calculated in all patients presenting with NF to provide an additional source for clinical outcome. A high LRINEC score could implicate a higher risk of mortality. Especially in elderly patients, with a cardiac history, more than two comorbidities or a lactate level greater than 1.7 mmol/L.

• #11 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The mean age of survivors is 35 years. The mean age of nonsurvivors is 49 years. […] A retrospective review by Cheng et al showed that upper extremity necrotizing fasciitis has a high mortality rate. […] In a study by Friederichs et al indicated that necrotizing fasciitis tends to have a worse outcome when acquired iatrogenically via injection or infiltration than it does when acquired in other ways, with higher mortality and amputation rates (67% and 73%, respectively) found. […] In a study by Rouse et al, the overall mortality rate was 73% (20 of 27 patients). […] Similarly, McHenry et al reported that the average time from admission to operation was 90 hours in nonsurvivors of necrotizing soft-tissue infections; in survivors, this average time was 25 hours. […] Necrotizing fasciitis survivors may have a shorter life span than population controls, owing to infectious causes such as pneumonia, cholecystitis, urinary tract infections, and sepsis.

• #12

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  A statistically different mortality rate was found in patients over the age of 60, patients with a history of cardiovascular disease, two or more comorbidities or a lactate level of 1.7 mmol/L or higher. […] Our data supported these findings. A cut-off point of 1.7 mmol/L was chosen based on daily practice (33.7% vs 8.7%, p=0.036). […] An increased age is also associated with a poor outcome in patients presenting with NF. With a cut-off of an age over 60 or 65 years in past studies. Our data supported both these findings, with a mortality of 44.3% in patients ≥60 years vs. 19.4%<60 years (p = 0.006) and a mortality of 47.6% in patients≥65 years vs. 23.5%<65 years (p = 0.012). [...] Knowing mortality is directly related with time from presentation till surgery, we recommend that the LRINEC score should be calculated in all patients who are presented with the suspicion of NF. Providing an extra tool for diagnosis. Based on our research, if there is a score over 7.5 we recommend to prepare and inform the relatives that this could be an indication of an unfavourable outcome. Especially in elderly patients, with a cardiovascular history, two or more comorbidities or a lactate greater than 1.7 mmol/L.

• #13

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Univariate logistic regression, exp(B), on patient mortality risk factors is shown in Table 4. Age 60 years, hypertension and/or dyslipidemia, renal disease, ICU admission, requirement of a blood transfusion, presence of GABS, elevated urea and creatinine, and abnormal platelets were all significantly associated with mortality (P .05). […] A series of multivariate regressions with block entry were performed. Comparing critical values of 2 difference in 2 log likelihood found that creatinine, blood platelets, the presence of GABS, and age 60 years provided the best model fit (Table 5). This was vastly improved in a final model employing a binary variable for creatinine (normal and high) and platelets (normal and abnormal). This final model provided 90% prediction in classification. In order of impact, high creatinine, presence of GABS, abnormal platelets, and age 60 years contributed to the final predictive model. The Nagelkerke R 2 indicates a 0.32 improvement in model fit with the predictors.

• #14 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #15

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Univariate logistic regression, exp(B), on patient mortality risk factors is shown in Table 4. Age 60 years, hypertension and/or dyslipidemia, renal disease, ICU admission, requirement of a blood transfusion, presence of GABS, elevated urea and creatinine, and abnormal platelets were all significantly associated with mortality (P .05). […] A series of multivariate regressions with block entry were performed. Comparing critical values of 2 difference in 2 log likelihood found that creatinine, blood platelets, the presence of GABS, and age 60 years provided the best model fit (Table 5). This was vastly improved in a final model employing a binary variable for creatinine (normal and high) and platelets (normal and abnormal). This final model provided 90% prediction in classification. In order of impact, high creatinine, presence of GABS, abnormal platelets, and age 60 years contributed to the final predictive model. The Nagelkerke R 2 indicates a 0.32 improvement in model fit with the predictors.

• #16

  https://link.springer.com/article/10.1007/s11751-011-0116-1

  In spite of recent progress in the treatment methods, the outcome has not improved and mortality rate is still high. […] The overall mortality rate was 20.8%, and mortality rates in patients with upper and lower limb infection were 22.2 and 20%, respectively. In our series, the risk of amputation was significantly higher in lower limb involvement, but survival rate in upper or lower limb involvement was not significantly different. […] According to our findings at the time of admission, the presence of hyponatremia, hyperkalemia, and increased band cell count in peripheral blood are risk factors for mortality, and the presence of diabetes mellitus increased the risk of amputation in lower limbs. So, lower threshold to amputation may be mandatory in this group of patients.

• #17

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  A statistically different mortality rate was found in patients over the age of 60, patients with a history of cardiovascular disease, two or more comorbidities or a lactate level of 1.7 mmol/L or higher. […] Our data supported these findings. A cut-off point of 1.7 mmol/L was chosen based on daily practice (33.7% vs 8.7%, p=0.036). […] An increased age is also associated with a poor outcome in patients presenting with NF. With a cut-off of an age over 60 or 65 years in past studies. Our data supported both these findings, with a mortality of 44.3% in patients ≥60 years vs. 19.4%<60 years (p = 0.006) and a mortality of 47.6% in patients≥65 years vs. 23.5%<65 years (p = 0.012). [...] Knowing mortality is directly related with time from presentation till surgery, we recommend that the LRINEC score should be calculated in all patients who are presented with the suspicion of NF. Providing an extra tool for diagnosis. Based on our research, if there is a score over 7.5 we recommend to prepare and inform the relatives that this could be an indication of an unfavourable outcome. Especially in elderly patients, with a cardiovascular history, two or more comorbidities or a lactate greater than 1.7 mmol/L.

• #18

  https://link.springer.com/article/10.1007/s11751-011-0116-1

  In spite of recent progress in the treatment methods, the outcome has not improved and mortality rate is still high. […] The overall mortality rate was 20.8%, and mortality rates in patients with upper and lower limb infection were 22.2 and 20%, respectively. In our series, the risk of amputation was significantly higher in lower limb involvement, but survival rate in upper or lower limb involvement was not significantly different. […] According to our findings at the time of admission, the presence of hyponatremia, hyperkalemia, and increased band cell count in peripheral blood are risk factors for mortality, and the presence of diabetes mellitus increased the risk of amputation in lower limbs. So, lower threshold to amputation may be mandatory in this group of patients.

• #19 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The reported mortality in patients with necrotizing fasciitis has ranged from 20% to as high as 80%. […] Poor prognosis in necrotizing fasciitis has been linked to infection with certain streptococcal strains. […] A retrospective study by Hsiao et al found that Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell (WBC) count greater than 10% were independent positive predictors of mortality in patients with necrotizing fasciitis, while streptococcal and staphylococcal infections were not identified as predictors of mortality. […] A retrospective study by Illg et al indicated that necrotizing fasciitis tends to be more severe in persons categorized as overweight. […] A retrospective study by Momtaz et al indicated that in persons with necrotizing fasciitis, the amputation rate is greater in those with lower socioeconomic status (SES).

• #20 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #21

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  Necrotizing fasciitis (NF) is a severe soft tissue infection with a high morbidity and mortality. With early diagnosis and treatment this could be reduced. […] In this study, we search for prognostic factors for mortality in necrotizing fasciitis. […] The overall mortality was 31.7% (N=39). […] Patients who died as the result of NF had a significantly higher median LRINEC score (8 vs. 7, p=0.034). Other parameters found to be associated with mortality are age≥60 years, cardiovascular disease in the medical history, 2 comorbidities, and lactate level greater than 1.7 mmol/L. […] LRINEC score should be calculated in all patients presenting with NF to provide an additional source for clinical outcome. A high LRINEC score could implicate a higher risk of mortality. Especially in elderly patients, with a cardiac history, more than two comorbidities or a lactate level greater than 1.7 mmol/L.

• #22

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  A statistically different mortality rate was found in patients over the age of 60, patients with a history of cardiovascular disease, two or more comorbidities or a lactate level of 1.7 mmol/L or higher. […] Our data supported these findings. A cut-off point of 1.7 mmol/L was chosen based on daily practice (33.7% vs 8.7%, p=0.036). […] An increased age is also associated with a poor outcome in patients presenting with NF. With a cut-off of an age over 60 or 65 years in past studies. Our data supported both these findings, with a mortality of 44.3% in patients ≥60 years vs. 19.4%<60 years (p = 0.006) and a mortality of 47.6% in patients≥65 years vs. 23.5%<65 years (p = 0.012). [...] Knowing mortality is directly related with time from presentation till surgery, we recommend that the LRINEC score should be calculated in all patients who are presented with the suspicion of NF. Providing an extra tool for diagnosis. Based on our research, if there is a score over 7.5 we recommend to prepare and inform the relatives that this could be an indication of an unfavourable outcome. Especially in elderly patients, with a cardiovascular history, two or more comorbidities or a lactate greater than 1.7 mmol/L.

• #23

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Univariate logistic regression, exp(B), on patient mortality risk factors is shown in Table 4. Age 60 years, hypertension and/or dyslipidemia, renal disease, ICU admission, requirement of a blood transfusion, presence of GABS, elevated urea and creatinine, and abnormal platelets were all significantly associated with mortality (P .05). […] A series of multivariate regressions with block entry were performed. Comparing critical values of 2 difference in 2 log likelihood found that creatinine, blood platelets, the presence of GABS, and age 60 years provided the best model fit (Table 5). This was vastly improved in a final model employing a binary variable for creatinine (normal and high) and platelets (normal and abnormal). This final model provided 90% prediction in classification. In order of impact, high creatinine, presence of GABS, abnormal platelets, and age 60 years contributed to the final predictive model. The Nagelkerke R 2 indicates a 0.32 improvement in model fit with the predictors.

• #24

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Univariate logistic regression, exp(B), on patient mortality risk factors is shown in Table 4. Age 60 years, hypertension and/or dyslipidemia, renal disease, ICU admission, requirement of a blood transfusion, presence of GABS, elevated urea and creatinine, and abnormal platelets were all significantly associated with mortality (P .05). […] A series of multivariate regressions with block entry were performed. Comparing critical values of 2 difference in 2 log likelihood found that creatinine, blood platelets, the presence of GABS, and age 60 years provided the best model fit (Table 5). This was vastly improved in a final model employing a binary variable for creatinine (normal and high) and platelets (normal and abnormal). This final model provided 90% prediction in classification. In order of impact, high creatinine, presence of GABS, abnormal platelets, and age 60 years contributed to the final predictive model. The Nagelkerke R 2 indicates a 0.32 improvement in model fit with the predictors.

• #25 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #26

  https://link.springer.com/article/10.1007/s11751-011-0116-1

  Necrotizing fasciitis is a rapidly progressive infection and is a necrosis of the fascia and surrounding tissues. Despite recent advances in its management, outcomes have not improved and mortality rate is still high. Mortality rate was 20.8%. Twelve patients (50%) improved, while seven patients (29.2%) were complicated by limb loss. Mortality rates related to upper and lower limb involvement were similar (20% vs. 22.2%). The rates of gangrene and amputation in patients with diabetes mellitus were significantly higher than other comorbidities. Patients with gram-positive infections had significantly lower rates of amputation (15.4% vs. 54.5%, P = 0.04). We conclude that hyponatremia, hyperkalemia, and increased band cells in the peripheral blood of patients may be useful parameters in distinguishing life-threatening necrotizing fasciitis; hence, we recommended lower threshold to amputation during surgery for this group of patients.

• #27

  https://link.springer.com/article/10.1007/s11751-011-0116-1

  In spite of recent progress in the treatment methods, the outcome has not improved and mortality rate is still high. […] The overall mortality rate was 20.8%, and mortality rates in patients with upper and lower limb infection were 22.2 and 20%, respectively. In our series, the risk of amputation was significantly higher in lower limb involvement, but survival rate in upper or lower limb involvement was not significantly different. […] According to our findings at the time of admission, the presence of hyponatremia, hyperkalemia, and increased band cell count in peripheral blood are risk factors for mortality, and the presence of diabetes mellitus increased the risk of amputation in lower limbs. So, lower threshold to amputation may be mandatory in this group of patients.

• #28

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  Necrotizing fasciitis (NF) is a severe soft tissue infection with a high morbidity and mortality. With early diagnosis and treatment this could be reduced. […] In this study, we search for prognostic factors for mortality in necrotizing fasciitis. […] The overall mortality was 31.7% (N=39). […] Patients who died as the result of NF had a significantly higher median LRINEC score (8 vs. 7, p=0.034). Other parameters found to be associated with mortality are age≥60 years, cardiovascular disease in the medical history, 2 comorbidities, and lactate level greater than 1.7 mmol/L. […] LRINEC score should be calculated in all patients presenting with NF to provide an additional source for clinical outcome. A high LRINEC score could implicate a higher risk of mortality. Especially in elderly patients, with a cardiac history, more than two comorbidities or a lactate level greater than 1.7 mmol/L.

• #29 Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

  https://www.mdpi.com/2036-7449/16/3/35

  The age of the patient is the most important prognostic factor 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. […] 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. […] Our study showed an overall mortality rate of 18%, which is in line with the existing literature (12%; 22% and 32%) that also examined prognostic factors for NF and found an overall mortality rate. […] The statistically significant prognostic value of the LARINF score (p = 0.02) also appears plausible, as it adds a number of clinical indicators (such as heart/liver/renal insufficiency/obesity and immunosuppression) to the laboratory indicators, which, when evaluated individually in other studies (>2 comorbidities), also yielded significant prognostic values. […] Our findings suggest that approximately one-quarter of patients admitted to an intensive care unit with a diagnosis of necrotizing fasciitis do not survive.

• #30 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #31 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The reported mortality in patients with necrotizing fasciitis has ranged from 20% to as high as 80%. […] Poor prognosis in necrotizing fasciitis has been linked to infection with certain streptococcal strains. […] A retrospective study by Hsiao et al found that Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell (WBC) count greater than 10% were independent positive predictors of mortality in patients with necrotizing fasciitis, while streptococcal and staphylococcal infections were not identified as predictors of mortality. […] A retrospective study by Illg et al indicated that necrotizing fasciitis tends to be more severe in persons categorized as overweight. […] A retrospective study by Momtaz et al indicated that in persons with necrotizing fasciitis, the amputation rate is greater in those with lower socioeconomic status (SES).

• #32 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The reported mortality in patients with necrotizing fasciitis has ranged from 20% to as high as 80%. […] Poor prognosis in necrotizing fasciitis has been linked to infection with certain streptococcal strains. […] A retrospective study by Hsiao et al found that Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell (WBC) count greater than 10% were independent positive predictors of mortality in patients with necrotizing fasciitis, while streptococcal and staphylococcal infections were not identified as predictors of mortality. […] A retrospective study by Illg et al indicated that necrotizing fasciitis tends to be more severe in persons categorized as overweight. […] A retrospective study by Momtaz et al indicated that in persons with necrotizing fasciitis, the amputation rate is greater in those with lower socioeconomic status (SES).

• #33

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Univariate logistic regression, exp(B), on patient mortality risk factors is shown in Table 4. Age 60 years, hypertension and/or dyslipidemia, renal disease, ICU admission, requirement of a blood transfusion, presence of GABS, elevated urea and creatinine, and abnormal platelets were all significantly associated with mortality (P .05). […] A series of multivariate regressions with block entry were performed. Comparing critical values of 2 difference in 2 log likelihood found that creatinine, blood platelets, the presence of GABS, and age 60 years provided the best model fit (Table 5). This was vastly improved in a final model employing a binary variable for creatinine (normal and high) and platelets (normal and abnormal). This final model provided 90% prediction in classification. In order of impact, high creatinine, presence of GABS, abnormal platelets, and age 60 years contributed to the final predictive model. The Nagelkerke R 2 indicates a 0.32 improvement in model fit with the predictors.

• #34

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  This study presents an analysis of risk factors in one of the largest known cohorts of patients with NF using a combination of clinical and administrative data. Age 60 years, elevated creatinine, abnormal platelets, and GABS infection were shown to significantly increase the risk of mortality in patients with NF.

• #35 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The reported mortality in patients with necrotizing fasciitis has ranged from 20% to as high as 80%. […] Poor prognosis in necrotizing fasciitis has been linked to infection with certain streptococcal strains. […] A retrospective study by Hsiao et al found that Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell (WBC) count greater than 10% were independent positive predictors of mortality in patients with necrotizing fasciitis, while streptococcal and staphylococcal infections were not identified as predictors of mortality. […] A retrospective study by Illg et al indicated that necrotizing fasciitis tends to be more severe in persons categorized as overweight. […] A retrospective study by Momtaz et al indicated that in persons with necrotizing fasciitis, the amputation rate is greater in those with lower socioeconomic status (SES).

• #36

  https://link.springer.com/article/10.1007/s11751-011-0116-1

  Necrotizing fasciitis is a rapidly progressive infection and is a necrosis of the fascia and surrounding tissues. Despite recent advances in its management, outcomes have not improved and mortality rate is still high. Mortality rate was 20.8%. Twelve patients (50%) improved, while seven patients (29.2%) were complicated by limb loss. Mortality rates related to upper and lower limb involvement were similar (20% vs. 22.2%). The rates of gangrene and amputation in patients with diabetes mellitus were significantly higher than other comorbidities. Patients with gram-positive infections had significantly lower rates of amputation (15.4% vs. 54.5%, P = 0.04). We conclude that hyponatremia, hyperkalemia, and increased band cells in the peripheral blood of patients may be useful parameters in distinguishing life-threatening necrotizing fasciitis; hence, we recommended lower threshold to amputation during surgery for this group of patients.

• #37 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  The in-hospital mortality rate was 27.6%. […] Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR)=2.88, P=0.003), ineligibility for HBOT despite clinical indication (OR=8.59, P=0.005), pathogens in blood cultures (OR=3.36, P=0.002), complications (OR=10.35, P0.001) and sepsis/organ dysfunction (OR=19.58, P=0.001). […] In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P=0.022). […] These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. […] In patients eligible for HBOT, our data point to a beneficial effect of this procedure. […] In our study, ineligibility for HBOT was associated with increased mortality and significantly worse outcome despite early and frequent surgical debridements, extensive antibiotic therapy and intense supportive care.

• #38 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #39

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  Necrotizing fasciitis (NF) is a severe soft tissue infection with a high morbidity and mortality. With early diagnosis and treatment this could be reduced. […] In this study, we search for prognostic factors for mortality in necrotizing fasciitis. […] The overall mortality was 31.7% (N=39). […] Patients who died as the result of NF had a significantly higher median LRINEC score (8 vs. 7, p=0.034). Other parameters found to be associated with mortality are age≥60 years, cardiovascular disease in the medical history, 2 comorbidities, and lactate level greater than 1.7 mmol/L. […] LRINEC score should be calculated in all patients presenting with NF to provide an additional source for clinical outcome. A high LRINEC score could implicate a higher risk of mortality. Especially in elderly patients, with a cardiac history, more than two comorbidities or a lactate level greater than 1.7 mmol/L.

• #40 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #41 Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

  https://www.mdpi.com/2036-7449/16/3/35

  The age of the patient is the most important prognostic factor 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. […] 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. […] Our study showed an overall mortality rate of 18%, which is in line with the existing literature (12%; 22% and 32%) that also examined prognostic factors for NF and found an overall mortality rate. […] The statistically significant prognostic value of the LARINF score (p = 0.02) also appears plausible, as it adds a number of clinical indicators (such as heart/liver/renal insufficiency/obesity and immunosuppression) to the laboratory indicators, which, when evaluated individually in other studies (>2 comorbidities), also yielded significant prognostic values. […] Our findings suggest that approximately one-quarter of patients admitted to an intensive care unit with a diagnosis of necrotizing fasciitis do not survive.

• #42 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  The in-hospital mortality rate was 27.6%. […] Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR)=2.88, P=0.003), ineligibility for HBOT despite clinical indication (OR=8.59, P=0.005), pathogens in blood cultures (OR=3.36, P=0.002), complications (OR=10.35, P0.001) and sepsis/organ dysfunction (OR=19.58, P=0.001). […] In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P=0.022). […] These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. […] In patients eligible for HBOT, our data point to a beneficial effect of this procedure. […] In our study, ineligibility for HBOT was associated with increased mortality and significantly worse outcome despite early and frequent surgical debridements, extensive antibiotic therapy and intense supportive care.

• #43 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  The in-hospital mortality rate was 27.6%. […] Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR)=2.88, P=0.003), ineligibility for HBOT despite clinical indication (OR=8.59, P=0.005), pathogens in blood cultures (OR=3.36, P=0.002), complications (OR=10.35, P0.001) and sepsis/organ dysfunction (OR=19.58, P=0.001). […] In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P=0.022). […] These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. […] In patients eligible for HBOT, our data point to a beneficial effect of this procedure. […] In our study, ineligibility for HBOT was associated with increased mortality and significantly worse outcome despite early and frequent surgical debridements, extensive antibiotic therapy and intense supportive care.

• #44 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #45 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The mean age of survivors is 35 years. The mean age of nonsurvivors is 49 years. […] A retrospective review by Cheng et al showed that upper extremity necrotizing fasciitis has a high mortality rate. […] In a study by Friederichs et al indicated that necrotizing fasciitis tends to have a worse outcome when acquired iatrogenically via injection or infiltration than it does when acquired in other ways, with higher mortality and amputation rates (67% and 73%, respectively) found. […] In a study by Rouse et al, the overall mortality rate was 73% (20 of 27 patients). […] Similarly, McHenry et al reported that the average time from admission to operation was 90 hours in nonsurvivors of necrotizing soft-tissue infections; in survivors, this average time was 25 hours. […] Necrotizing fasciitis survivors may have a shorter life span than population controls, owing to infectious causes such as pneumonia, cholecystitis, urinary tract infections, and sepsis.

• #46

  https://link.springer.com/article/10.1007/s11751-011-0116-1

  In spite of recent progress in the treatment methods, the outcome has not improved and mortality rate is still high. […] The overall mortality rate was 20.8%, and mortality rates in patients with upper and lower limb infection were 22.2 and 20%, respectively. In our series, the risk of amputation was significantly higher in lower limb involvement, but survival rate in upper or lower limb involvement was not significantly different. […] According to our findings at the time of admission, the presence of hyponatremia, hyperkalemia, and increased band cell count in peripheral blood are risk factors for mortality, and the presence of diabetes mellitus increased the risk of amputation in lower limbs. So, lower threshold to amputation may be mandatory in this group of patients.

• #47 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  The in-hospital mortality rate was 27.6%. […] Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR)=2.88, P=0.003), ineligibility for HBOT despite clinical indication (OR=8.59, P=0.005), pathogens in blood cultures (OR=3.36, P=0.002), complications (OR=10.35, P0.001) and sepsis/organ dysfunction (OR=19.58, P=0.001). […] In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P=0.022). […] These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. […] In patients eligible for HBOT, our data point to a beneficial effect of this procedure. […] In our study, ineligibility for HBOT was associated with increased mortality and significantly worse outcome despite early and frequent surgical debridements, extensive antibiotic therapy and intense supportive care.

• #48 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  HBOT was shown to significantly reduce the risk of amputation in patients with NSTI in earlier studies, which encourages its use in patients with limb localization. […] HBOT patients and patients without requirement of HBOT were more likely to survive (P=0.022) and return to their previous living environment without severe disabling impairment (P=0.008) than those ineligible for HBOT. […] In-hospital survival times were similar in patients without requirement of HBOT compared to HBOT patients, but shorter in the subgroup ineligible for HBOT (mean 82.5 vs. 91.8 vs. 50.3 days, median 106.3 vs. 81.7 vs. 16.5 days; P=0.045 in log rank test). […] The baseline multivariate logistic regression model adjusted for sex, age, localization of the NSTI, number of comorbidities and LRINEC showed an increased risk of mortality with rising age (odds ratio (OR)=1.03, P=0.017) and infection in a problem localization (OR=2.88, P=0.003). […] A larger number of debridements (OR=0.83, P=0.001), VAC therapy (OR=0.17, P=0.001), defect closure with mesh graft (OR=0.06, P=0.001) and with flaps (OR=0.09, P=0.024) and a longer duration of the hospital stay (OR=0.94, P=0.001) were associated with a lower risk of mortality.

• #49 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The mean age of survivors is 35 years. The mean age of nonsurvivors is 49 years. […] A retrospective review by Cheng et al showed that upper extremity necrotizing fasciitis has a high mortality rate. […] In a study by Friederichs et al indicated that necrotizing fasciitis tends to have a worse outcome when acquired iatrogenically via injection or infiltration than it does when acquired in other ways, with higher mortality and amputation rates (67% and 73%, respectively) found. […] In a study by Rouse et al, the overall mortality rate was 73% (20 of 27 patients). […] Similarly, McHenry et al reported that the average time from admission to operation was 90 hours in nonsurvivors of necrotizing soft-tissue infections; in survivors, this average time was 25 hours. […] Necrotizing fasciitis survivors may have a shorter life span than population controls, owing to infectious causes such as pneumonia, cholecystitis, urinary tract infections, and sepsis.

• #50 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The mean age of survivors is 35 years. The mean age of nonsurvivors is 49 years. […] A retrospective review by Cheng et al showed that upper extremity necrotizing fasciitis has a high mortality rate. […] In a study by Friederichs et al indicated that necrotizing fasciitis tends to have a worse outcome when acquired iatrogenically via injection or infiltration than it does when acquired in other ways, with higher mortality and amputation rates (67% and 73%, respectively) found. […] In a study by Rouse et al, the overall mortality rate was 73% (20 of 27 patients). […] Similarly, McHenry et al reported that the average time from admission to operation was 90 hours in nonsurvivors of necrotizing soft-tissue infections; in survivors, this average time was 25 hours. […] Necrotizing fasciitis survivors may have a shorter life span than population controls, owing to infectious causes such as pneumonia, cholecystitis, urinary tract infections, and sepsis.

• #51 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  The in-hospital mortality rate was 27.6%. […] Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR)=2.88, P=0.003), ineligibility for HBOT despite clinical indication (OR=8.59, P=0.005), pathogens in blood cultures (OR=3.36, P=0.002), complications (OR=10.35, P0.001) and sepsis/organ dysfunction (OR=19.58, P=0.001). […] In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P=0.022). […] These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. […] In patients eligible for HBOT, our data point to a beneficial effect of this procedure. […] In our study, ineligibility for HBOT was associated with increased mortality and significantly worse outcome despite early and frequent surgical debridements, extensive antibiotic therapy and intense supportive care.

• #52 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  HBOT was shown to significantly reduce the risk of amputation in patients with NSTI in earlier studies, which encourages its use in patients with limb localization. […] HBOT patients and patients without requirement of HBOT were more likely to survive (P=0.022) and return to their previous living environment without severe disabling impairment (P=0.008) than those ineligible for HBOT. […] In-hospital survival times were similar in patients without requirement of HBOT compared to HBOT patients, but shorter in the subgroup ineligible for HBOT (mean 82.5 vs. 91.8 vs. 50.3 days, median 106.3 vs. 81.7 vs. 16.5 days; P=0.045 in log rank test). […] The baseline multivariate logistic regression model adjusted for sex, age, localization of the NSTI, number of comorbidities and LRINEC showed an increased risk of mortality with rising age (odds ratio (OR)=1.03, P=0.017) and infection in a problem localization (OR=2.88, P=0.003). […] A larger number of debridements (OR=0.83, P=0.001), VAC therapy (OR=0.17, P=0.001), defect closure with mesh graft (OR=0.06, P=0.001) and with flaps (OR=0.09, P=0.024) and a longer duration of the hospital stay (OR=0.94, P=0.001) were associated with a lower risk of mortality.

• #53 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  HBOT was shown to significantly reduce the risk of amputation in patients with NSTI in earlier studies, which encourages its use in patients with limb localization. […] HBOT patients and patients without requirement of HBOT were more likely to survive (P=0.022) and return to their previous living environment without severe disabling impairment (P=0.008) than those ineligible for HBOT. […] In-hospital survival times were similar in patients without requirement of HBOT compared to HBOT patients, but shorter in the subgroup ineligible for HBOT (mean 82.5 vs. 91.8 vs. 50.3 days, median 106.3 vs. 81.7 vs. 16.5 days; P=0.045 in log rank test). […] The baseline multivariate logistic regression model adjusted for sex, age, localization of the NSTI, number of comorbidities and LRINEC showed an increased risk of mortality with rising age (odds ratio (OR)=1.03, P=0.017) and infection in a problem localization (OR=2.88, P=0.003). […] A larger number of debridements (OR=0.83, P=0.001), VAC therapy (OR=0.17, P=0.001), defect closure with mesh graft (OR=0.06, P=0.001) and with flaps (OR=0.09, P=0.024) and a longer duration of the hospital stay (OR=0.94, P=0.001) were associated with a lower risk of mortality.

• #54 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  HBOT was shown to significantly reduce the risk of amputation in patients with NSTI in earlier studies, which encourages its use in patients with limb localization. […] HBOT patients and patients without requirement of HBOT were more likely to survive (P=0.022) and return to their previous living environment without severe disabling impairment (P=0.008) than those ineligible for HBOT. […] In-hospital survival times were similar in patients without requirement of HBOT compared to HBOT patients, but shorter in the subgroup ineligible for HBOT (mean 82.5 vs. 91.8 vs. 50.3 days, median 106.3 vs. 81.7 vs. 16.5 days; P=0.045 in log rank test). […] The baseline multivariate logistic regression model adjusted for sex, age, localization of the NSTI, number of comorbidities and LRINEC showed an increased risk of mortality with rising age (odds ratio (OR)=1.03, P=0.017) and infection in a problem localization (OR=2.88, P=0.003). […] A larger number of debridements (OR=0.83, P=0.001), VAC therapy (OR=0.17, P=0.001), defect closure with mesh graft (OR=0.06, P=0.001) and with flaps (OR=0.09, P=0.024) and a longer duration of the hospital stay (OR=0.94, P=0.001) were associated with a lower risk of mortality.

• #55 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  HBOT was shown to significantly reduce the risk of amputation in patients with NSTI in earlier studies, which encourages its use in patients with limb localization. […] HBOT patients and patients without requirement of HBOT were more likely to survive (P=0.022) and return to their previous living environment without severe disabling impairment (P=0.008) than those ineligible for HBOT. […] In-hospital survival times were similar in patients without requirement of HBOT compared to HBOT patients, but shorter in the subgroup ineligible for HBOT (mean 82.5 vs. 91.8 vs. 50.3 days, median 106.3 vs. 81.7 vs. 16.5 days; P=0.045 in log rank test). […] The baseline multivariate logistic regression model adjusted for sex, age, localization of the NSTI, number of comorbidities and LRINEC showed an increased risk of mortality with rising age (odds ratio (OR)=1.03, P=0.017) and infection in a problem localization (OR=2.88, P=0.003). […] A larger number of debridements (OR=0.83, P=0.001), VAC therapy (OR=0.17, P=0.001), defect closure with mesh graft (OR=0.06, P=0.001) and with flaps (OR=0.09, P=0.024) and a longer duration of the hospital stay (OR=0.94, P=0.001) were associated with a lower risk of mortality.

• #56 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  HBOT was shown to significantly reduce the risk of amputation in patients with NSTI in earlier studies, which encourages its use in patients with limb localization. […] HBOT patients and patients without requirement of HBOT were more likely to survive (P=0.022) and return to their previous living environment without severe disabling impairment (P=0.008) than those ineligible for HBOT. […] In-hospital survival times were similar in patients without requirement of HBOT compared to HBOT patients, but shorter in the subgroup ineligible for HBOT (mean 82.5 vs. 91.8 vs. 50.3 days, median 106.3 vs. 81.7 vs. 16.5 days; P=0.045 in log rank test). […] The baseline multivariate logistic regression model adjusted for sex, age, localization of the NSTI, number of comorbidities and LRINEC showed an increased risk of mortality with rising age (odds ratio (OR)=1.03, P=0.017) and infection in a problem localization (OR=2.88, P=0.003). […] A larger number of debridements (OR=0.83, P=0.001), VAC therapy (OR=0.17, P=0.001), defect closure with mesh graft (OR=0.06, P=0.001) and with flaps (OR=0.09, P=0.024) and a longer duration of the hospital stay (OR=0.94, P=0.001) were associated with a lower risk of mortality.

• #57 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  HBOT was shown to significantly reduce the risk of amputation in patients with NSTI in earlier studies, which encourages its use in patients with limb localization. […] HBOT patients and patients without requirement of HBOT were more likely to survive (P=0.022) and return to their previous living environment without severe disabling impairment (P=0.008) than those ineligible for HBOT. […] In-hospital survival times were similar in patients without requirement of HBOT compared to HBOT patients, but shorter in the subgroup ineligible for HBOT (mean 82.5 vs. 91.8 vs. 50.3 days, median 106.3 vs. 81.7 vs. 16.5 days; P=0.045 in log rank test). […] The baseline multivariate logistic regression model adjusted for sex, age, localization of the NSTI, number of comorbidities and LRINEC showed an increased risk of mortality with rising age (odds ratio (OR)=1.03, P=0.017) and infection in a problem localization (OR=2.88, P=0.003). […] A larger number of debridements (OR=0.83, P=0.001), VAC therapy (OR=0.17, P=0.001), defect closure with mesh graft (OR=0.06, P=0.001) and with flaps (OR=0.09, P=0.024) and a longer duration of the hospital stay (OR=0.94, P=0.001) were associated with a lower risk of mortality.

• #58 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The reported mortality in patients with necrotizing fasciitis has ranged from 20% to as high as 80%. […] Poor prognosis in necrotizing fasciitis has been linked to infection with certain streptococcal strains. […] A retrospective study by Hsiao et al found that Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell (WBC) count greater than 10% were independent positive predictors of mortality in patients with necrotizing fasciitis, while streptococcal and staphylococcal infections were not identified as predictors of mortality. […] A retrospective study by Illg et al indicated that necrotizing fasciitis tends to be more severe in persons categorized as overweight. […] A retrospective study by Momtaz et al indicated that in persons with necrotizing fasciitis, the amputation rate is greater in those with lower socioeconomic status (SES).

• #59 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  The in-hospital mortality rate was 27.6%. […] Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR)=2.88, P=0.003), ineligibility for HBOT despite clinical indication (OR=8.59, P=0.005), pathogens in blood cultures (OR=3.36, P=0.002), complications (OR=10.35, P0.001) and sepsis/organ dysfunction (OR=19.58, P=0.001). […] In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P=0.022). […] These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. […] In patients eligible for HBOT, our data point to a beneficial effect of this procedure. […] In our study, ineligibility for HBOT was associated with increased mortality and significantly worse outcome despite early and frequent surgical debridements, extensive antibiotic therapy and intense supportive care.

• #60 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #61 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis. […] Similarly, a retrospective study by Adachi et al reported that in patients with necrotizing fasciitis, renal dysfunction predicts fatal outcomes.

• #62

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age 60 years, elevated creatinine, abnormal blood platelets, and group A -hemolytic Streptococcus (GABS) infection. […] Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age 60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality. […] Of the 340 patients in this study, 43 died in hospital (12.7%). The deceased cohort was significantly older (P .05). Survivors had a significantly higher rate of wound closure via graft, free tissue transfer, or other closure compared to the deceased cohort (P .05). The deceased cohort also had a higher rate of ICU admission, more days in ICU, and received more packed red blood cells (P .05).

• #63

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Univariate logistic regression, exp(B), on patient mortality risk factors is shown in Table 4. Age 60 years, hypertension and/or dyslipidemia, renal disease, ICU admission, requirement of a blood transfusion, presence of GABS, elevated urea and creatinine, and abnormal platelets were all significantly associated with mortality (P .05). […] A series of multivariate regressions with block entry were performed. Comparing critical values of 2 difference in 2 log likelihood found that creatinine, blood platelets, the presence of GABS, and age 60 years provided the best model fit (Table 5). This was vastly improved in a final model employing a binary variable for creatinine (normal and high) and platelets (normal and abnormal). This final model provided 90% prediction in classification. In order of impact, high creatinine, presence of GABS, abnormal platelets, and age 60 years contributed to the final predictive model. The Nagelkerke R 2 indicates a 0.32 improvement in model fit with the predictors.

• #64

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Univariate logistic regression, exp(B), on patient mortality risk factors is shown in Table 4. Age 60 years, hypertension and/or dyslipidemia, renal disease, ICU admission, requirement of a blood transfusion, presence of GABS, elevated urea and creatinine, and abnormal platelets were all significantly associated with mortality (P .05). […] A series of multivariate regressions with block entry were performed. Comparing critical values of 2 difference in 2 log likelihood found that creatinine, blood platelets, the presence of GABS, and age 60 years provided the best model fit (Table 5). This was vastly improved in a final model employing a binary variable for creatinine (normal and high) and platelets (normal and abnormal). This final model provided 90% prediction in classification. In order of impact, high creatinine, presence of GABS, abnormal platelets, and age 60 years contributed to the final predictive model. The Nagelkerke R 2 indicates a 0.32 improvement in model fit with the predictors.

• #65 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The mean age of survivors is 35 years. The mean age of nonsurvivors is 49 years. […] A retrospective review by Cheng et al showed that upper extremity necrotizing fasciitis has a high mortality rate. […] In a study by Friederichs et al indicated that necrotizing fasciitis tends to have a worse outcome when acquired iatrogenically via injection or infiltration than it does when acquired in other ways, with higher mortality and amputation rates (67% and 73%, respectively) found. […] In a study by Rouse et al, the overall mortality rate was 73% (20 of 27 patients). […] Similarly, McHenry et al reported that the average time from admission to operation was 90 hours in nonsurvivors of necrotizing soft-tissue infections; in survivors, this average time was 25 hours. […] Necrotizing fasciitis survivors may have a shorter life span than population controls, owing to infectious causes such as pneumonia, cholecystitis, urinary tract infections, and sepsis.

• #66 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  If you have this condition, your best outcome will come from receiving an accurate diagnosis and quick treatment with antibiotics combined with surgery to remove the dead tissue. […] Necrotizing fasciitis (flesh-eating disease) gets worse quickly, destroying your tissue and causing things like organ failure. Even with treatment, 1 out of 3 people dies from this disease. […] You may need more than one surgery to manage necrotizing fasciitis. You may have scarring.

• #67

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age 60 years, elevated creatinine, abnormal blood platelets, and group A -hemolytic Streptococcus (GABS) infection. […] Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age 60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality. […] Of the 340 patients in this study, 43 died in hospital (12.7%). The deceased cohort was significantly older (P .05). Survivors had a significantly higher rate of wound closure via graft, free tissue transfer, or other closure compared to the deceased cohort (P .05). The deceased cohort also had a higher rate of ICU admission, more days in ICU, and received more packed red blood cells (P .05).

• #68 Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

  https://www.mdpi.com/2036-7449/16/3/35

  The age of the patient is the most important prognostic factor 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. […] 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. […] Our study showed an overall mortality rate of 18%, which is in line with the existing literature (12%; 22% and 32%) that also examined prognostic factors for NF and found an overall mortality rate. […] The statistically significant prognostic value of the LARINF score (p = 0.02) also appears plausible, as it adds a number of clinical indicators (such as heart/liver/renal insufficiency/obesity and immunosuppression) to the laboratory indicators, which, when evaluated individually in other studies (>2 comorbidities), also yielded significant prognostic values. […] Our findings suggest that approximately one-quarter of patients admitted to an intensive care unit with a diagnosis of necrotizing fasciitis do not survive.

• #69 Outcome of necrotizing fasciitis and Fournier’s gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6

  The in-hospital mortality rate was 27.6%. […] Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR)=2.88, P=0.003), ineligibility for HBOT despite clinical indication (OR=8.59, P=0.005), pathogens in blood cultures (OR=3.36, P=0.002), complications (OR=10.35, P0.001) and sepsis/organ dysfunction (OR=19.58, P=0.001). […] In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P=0.022). […] These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. […] In patients eligible for HBOT, our data point to a beneficial effect of this procedure. […] In our study, ineligibility for HBOT was associated with increased mortality and significantly worse outcome despite early and frequent surgical debridements, extensive antibiotic therapy and intense supportive care.

• #70 Triple diagnostics for early detection of ambivalent necrotizing fasciitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-016-0108-z

  Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. […] The disease can be rapidly progressive and can have devastating outcome with many patients not surviving the infection (up to 70 % mortality rate reported in past series). […] Over the last decade, mortality rate has decreased to 20-40 % in reported series. […] In the present series 55 % suffered severe co-morbidities such as congestive heart failure, renal insufficiency or acute leukemia. […] Mortality due to necrotizing fasciitis was the outcome in two patients (12.5 %) and 2 additional patients died within the first 30 days after admission due to other pre-existing conditions (25 % total 30 day mortality). […] Mortality due to necrotizing fasciitis in this series was 12.5 % and overall mortality was 25 %, which is a fair result considering the large number of ASA IV classified patients.

• #71

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10467438/

  This study presents an analysis of risk factors in one of the largest known cohorts of patients with NF using a combination of clinical and administrative data. Age 60 years, elevated creatinine, abnormal platelets, and GABS infection were shown to significantly increase the risk of mortality in patients with NF.

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