Predicting Morbidity and Mortality in Patients with Lower Extremity Necrotizing Fasciitis

Objectives: Necrotizing fasciitis (NF) is a rare but limb- and life-threatening soft-tissue infection. It is among the most challenging surgical infections faced by surgeons, and is often accompanied by severe systemic toxicity. The aim of this study was to evaluate the predictive power of serum lactate and creatinine levels for mortality and morbidity in lower extremity NF.
Methods: A retrospective cohort analysis of 87 patients with lower extremity NF was performed to evaluate the management techniques and the amputation and survival rates according to serum lactate and creatinine levels as well as the time between the onset of symptoms and surgery.
Results: The mean time between the onset of symptoms and surgery was 3.7 days. As the time between the onset of symptoms and surgery increased, the rate of amputation and mortality significantly increased (p<0.001). In all, 66% of the mortality in the group was seen among the 12 patients who had a serum creatinine level greater than 2 mg/dL at the time of presentation. In 12 of 14 patients (85.7%) who underwent amputation/disarticulation, the mean serum lactate level was 5.7 mmol/L (range: 5.1-8.7 mmol/L), and the mean serum creatinine level was 1.92 mg/dL (range: 1.4 to.3.3 mg/dL). The high levels of serum creatinine and lactate were found to be statistically significant in terms of predicting mortality and amputation (p<0.001).
Conclusion: Based on the results of this study, it was determined that risk factors for mortality include age, late presentation, increased serum creatinine and lactate levels, and that these factors can predict the rate of death from NF at the time of presentation.

Alt ekstremite nekrotizan fasit olgularýnda mortalite ve morbiditenin belirlenmesi

Amaç: Nekrotizan fasiit (NF) hayatý ve ekstremiteyi tehdit edebilen, çok sýk görülmeyen bir yumuþak doku enfeksiyonudur. NF, baþ edilmesi en zor cerrahi enfeksiyonlardan biri olup, tabloya genellikle ileri sistemik toksisite de eþlik eder. Bu çalýþmanýn amacý alt ekstremite NF olgularýnda komorbid hastalýklarla birlikte serum laktat ve kreatinin seviyeleri ile, mortalite ve morbidite insidansý arasýndaki iliþkiyi deðerlendirmektir.
Yöntem: Bu çalýþmada, 87 alt ekstremite NF olgusunda tedavi þekli, serum laktat ve kreatinin seviyeleri ve semptomlarýn ilk baþlamasýyla, cerrahi uygulanan zaman arasýnda geçen süre ile amputasyon ve ortalama yaþam süresi arasýndaki iliþki deðerlendirilmiþtir.
Bulgular: Semptomlarýn baþlamasýyla cerrahi yapýlma zamaný arasýndaki ortalama süre 3.7 gün idi. Bu süre uzadýðýnda amputasyon ve mortalite anlamlý þekilde arttýðý saptanmýþtýr (p< 0.001). Serum kreatinin seviyesi 2 mg/dL’den fazla olan 12 hastada mortalite oraný % 66 olarak saptandý. Amputasyon/dezartikülasyon yapýlan 14 hastanýn 12’sinde (%85.7) ortalama serum laktat seviyesi 5.7 (5.1-8.7 arasý) mmol/L, ortalama serum kreatinin seviyesi ise 1.92 (1.4-3.3 arasý) mg/dL olarak saptandý. Baþvuru esnasýnda serum kreatinin ve laktat seviyesinin yüksek olmasýnýn, mortalite ve amputasyon görülme sýklýðýný istatistiksel olarak anlamlý þekilde arttýrdýðý saptanmýþtýr (p< 0.001).
Sonuç: Bu çalýþmanýn sonuçlarýna göre, alt ekstremite NF olgularýnda mortalite ve morbiditeyi arttýran baþlýca faktörler; ileri yaþ, geç baþvuru, baþvuru esnasýnda yüksek serum laktat ve kreatinin deðerleri olarak saptanmýþtýr. Ayrýca bu parametreler, ilk baþvuru esnasýnda hastalýðýn seyri açýsýndan da fikir veren parametreler olarak akýlda bulundurulmalýdýr.