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VOLUME 5 , ISSUE 2 ( May-August, 2020 ) > List of Articles

Original Article

Evaluation of Risk Factors for Amputation and Mortality in Patients of Necrotizing Fasciitis

Maulik Sharma, Rajkamal Kanojiya, Shefali Goyal

Citation Information : Sharma M, Kanojiya R, Goyal S. Evaluation of Risk Factors for Amputation and Mortality in Patients of Necrotizing Fasciitis. J Mahatma Gandhi Univ Med Sci Tech 2020; 5 (2):38-46.

DOI: 10.5005/jp-journals-10057-0130

License: CC BY-NC 4.0

Published Online: 12-04-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Background: Necrotizing fasciitis (NF) is a serious infection of the skin and soft tissues including subcutaneous tissue and fascia, which rapidly progresses along the deep fascia and becomes a medical and surgical urgency. Delayed treatment is associated with loss of limb and infection and is the most common cause of mortality. The purpose of our study is to identify the risk factors which may be used to predict amputation and mortality in patients with NF. Materials and methods: All adult patients presented in General Surgery OPD/emergency and plastic surgery OPD of MGUMST with NF were assessed, admitted, and treated with broad-spectrum antibiotics from January 2019 to June 2020. All routine blood parameters were evaluated and were provided proper emergency surgical treatment. The surgical interventions included incision and drainage, debridement, fasciotomy, and amputation. The clinical data and demographic characteristics within the first day of admission and after 48–72 hours were documented. Important data associated with the investigations and treatment of NF, i.e., wound appearance, site of infection, organisms involved, and laboratory data within the first day of admission and after 48–72 hours, surgical intervention and outcome, were documented. Patients were divided into two groups: survival and mortality which were further grouped into two groups: those with amputation and without amputation. Results: Among 100 patients with diagnosis of NF, 20% died and 10% underwent amputation. From multivariable analysis, the predictors of mortality among patients of NF were patients of age >60 years [risk ratio (RR) = 58.57, 95% CI = 3.64–941.85, p = 0.004], having diabetes mellitus (DM) (RR = 28.70, 95% CI = 1.78–461.51, p = 0.017), gangrene (RR = 3.86, 95% CI = 1.91–7.75, p = 0.0002), severe sepsis (RR = 158.14, 95% CI = 9.96–2508.89, p = 0.0003), involvement of multiple sites (RR = 9.06, 95% CI = 4.25–19.31, p = 0.0001), total leukocyte count (RR = 158.14, 95% CI = 9.96–2508.89, p = 0.0003), and serum creatinine (RR = 126.28, 95% CI = 7.92–2013.12, p = 0.0006) on admission and within 48–72 hours of admission and the independent predictors of amputation among patients of NF included having gangrene (RR = 173.73, 95% CI = 10.91–2764.80, p = 0.0003), severe sepsis (RR = 6.00, 95% CI = 1.86–19.26, p = 0.002), total leukocyte count (RR = 6.00, 95% CI = 1.86–19.26, p = 0.002), and serum creatinine (RR = 64.68, 95% CI = 3.92–1064.68, p = 0.003) on admission and within 48–72 hours of admission. Conclusion: In our study, we concluded that gangrene, severe sepsis, total leukocyte count >25,000, and serum creatinine values >1.6 mg/dL on admission as well as within 48–72 hours, as independent predictors for both amputation and mortality and some other factors like age >60 years, the involvement of multiple sites, DM mainly predicting the mortality rate independently.

  1. Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol 2006;20(4):365–369. DOI: 10.1111/j.1468-3083.2006.01487.x.
  2. Necrotizing fasciitis: reviewing the causes and treatment strategies. Adv Skin Wound Care 2007;20(5):288–293. DOI: 10.1097/01.ASW.0000269317.76380.3b.
  3. Necrotizing fasciitis in a renal transplant recipient treated with FK 506: the first reported case. Clin Nephrol 2001;56(6):481–485.
  4. Necrotising fasciitis of a limb. J Bone Joint Surg Br 2001;83(5):709–714. DOI: 10.1302/0301-620X.83B5.0830709.
  5. Diagnosing necrotizing fasciitis. Adv Skin Wound Care 2002;15(3):135–138. DOI: 10.1097/00129334-200205000-00010.
  6. Necrotizing soft tissue infections. Curr Opin Crit Care 2007;13(4):433–439. DOI: 10.1097/MCC.0b013e32825a6a1b.
  7. Necrotizing soft-tissue infections. J Am Acad Orthop Surg 2000;8(3):151–158. DOI: 10.5435/00124635-200005000-00002.
  8. Gas gangrene and necrotizing fasciitis in the upper extremity. J Surg Orthop Adv 2004;13(2):57–68.
  9. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. ANZ J Surg 2008;78(11):968–972. DOI: 10.1111/j.1445-2197.2008.04713.x.
  10. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221(5):558–563. DOI: 10.1097/00000658-199505000-00013.
  11. The epidemiology of necrotizing fasciitis including factors associated with death and amputation. Epidemiol Infect 2009;137(11):1609–1614. DOI: 10.1017/S0950268809002532.
  12. Necrotizing fasciitis in southeast Taiwan: clinical features, microbiology, and prognosis. Int J Infect Dis 2009;13(2):255–260. DOI: 10.1016/j.ijid.2008.04.015.
  13. Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study. ANZ J Surg 2013;83(5):365–370. DOI: 10.1111/j.1445-2197.2012.06251.x.
  14. An analysis of vulvar necrotizing fasciitis in the unique and ethnically diverse Hawaiian population. Hawaii Med J 2010;69(1):13–16.
  15. Amputation as a consequence of diabetes mellitus. An Epidemiolog Rev Phys Ther 1983;63(6):960–964. DOI: 10.1093/ptj/63.6.960.
  16. Predictors on mortality from necrotizng fasciitis in Sawanpracharak hospital, Nakhonsawan, Thailand. Chiang Mai Med J 2009;48(4):135–142.
  17. A retrospective review of necrotizing fasciitis in Thammasat University Hospital. J Med Assoc Thai 2010;93(Suppl 7):S246–S253.
  18. Necrotizing fasciitis. Can Fam Physician 2009;55:981–987.
  19. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg 2005;140(2):151–157. DOI: 10.1001/archsurg.140.2.151.
  20. Risk factors for primary major amputation in diabetic patients. Sao Paulo Med J 2006;124(2):66–70. DOI: 10.1590/S1516-31802006000200004.
  21. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–829. DOI: 10.1097/00003246-198510000-00009.
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