Department of Orthopaedics, Caritas Medical Centre, Shamshuipo, Kowloon, Hong Kong.
Hong Kong Med J. 2011 Apr;17(2):96-104.
To identify predictive factors for mortality of patients with upper limb necrotising fasciitis.
Retrospective study.
Six hospitals in Hong Kong.
Clinical records of 29 patients treated in the hospitals were traced and analysed.
Possible predictive factors for mortality as evaluated by application of Fisher's test.
Overall mortality was 28%. Digital infections conferred a lower mortality, but progressive necrosis necessitated amputation. Vibrio vulnificus was the commonest organism identified in association with marine injury and in patients with cirrhosis. Prognostic indicators with decreasing significance include deranged renal and liver function, thrombocytopaenia, proximal involvement (elbow or above) initially, and presence of hypotension upon admission.
With a P value of less than 0.05, deranged renal and liver function, thrombocytopaenia, initial proximal involvement, and hypotension on admission were predictors of mortality in necrotising fasciitis affecting the upper limbs. The ALERTS (Abnormal Liver function, Extent of infection, Renal impairment, Thrombocytopenia, and Shock) score with a cutoff of 3 appeared to predict mortality.
确定上肢坏死性筋膜炎患者死亡的预测因素。
回顾性研究。
香港的六家医院。
追踪并分析了在这些医院接受治疗的 29 名患者的临床记录。
应用 Fisher 检验评估的死亡的可能预测因素。
总体死亡率为 28%。手指感染的死亡率较低，但进行性坏死需要截肢。创伤与海洋有关的病例和肝硬化患者中，常见的病原体是创伤弧菌。预后指标的重要性依次降低，包括肾功能和肝功能异常、血小板减少症、最初为近端受累（肘部或以上）以及入院时出现低血压。
有 5 个因素（肾功能和肝功能异常、血小板减少症、初始近端受累、入院时低血压）的 P 值均小于 0.05，这些是上肢坏死性筋膜炎导致死亡的预测因素。ALERTS（肝异常、感染范围、肾功能损害、血小板减少和休克）评分的截断值为 3，似乎可以预测死亡率。
