Wall D B, de Virgilio C, Black S, Klein S R
Department of Surgery, Harbor-University of California Los Angeles Medical Center, Torrance 90509, USA.
Am J Surg. 2000 Jan;179(1):17-21. doi: 10.1016/s0002-9610(99)00259-7.
Optimal treatment of necrotizing fasciitis (NF) requires rapid diagnosis. The purpose of the study was to identify objective admission measurements that help differentiate NF from nonnecrotizing (non-NF) infection and, among NF patients, to identify admission factors that predict mortality.
Twenty-one NF cases were paired with matched non-NF controls. Statistical comparison of admission vital signs, laboratory values, and radiographic studies was performed.
On multivariate analysis, admission white blood cell count (WBC) >14 x 10(9)/L, serum sodium <135 mmol/L, and blood urea nitrogen (BUN) >15 mg/dL separated NF from non-NF patients. Mortality for NF patients was predicted by admission WBC >30 x 10(9)/L. Mortality was also significantly increased for patients transferred from an outside institution prior to definitive therapy.
Objective admission criteria (elevated WBC and BUN and decreased serum sodium) can assist in distinguishing NF from non-NF infections. The best objective predictor of mortality in NF patients is marked elevation of admission WBC.
坏死性筋膜炎（NF）的最佳治疗需要快速诊断。本研究的目的是确定有助于区分NF与非坏死性（非NF）感染的客观入院指标，并在NF患者中确定预测死亡率的入院因素。
21例NF病例与匹配的非NF对照配对。对入院时的生命体征、实验室检查值和影像学检查进行统计学比较。
多因素分析显示，入院时白细胞计数（WBC）>14×10⁹/L、血清钠<135 mmol/L和血尿素氮（BUN）>15 mg/dL可将NF患者与非NF患者区分开来。NF患者的死亡率可通过入院时WBC>30×10⁹/L预测。在确定性治疗前从外部机构转入的患者死亡率也显著增加。
客观的入院标准（WBC和BUN升高以及血清钠降低）有助于区分NF与非NF感染。NF患者死亡率的最佳客观预测指标是入院时WBC显著升高。
