Factors affecting mortality in Hong Kong patients with upper limb necrotising fasciitis.

OBJECTIVE

To identify predictive factors for mortality of patients with upper limb necrotising fasciitis.

DESIGN

Retrospective study.

SETTING

Six hospitals in Hong Kong.

PATIENTS

Clinical records of 29 patients treated in the hospitals were traced and analysed.

MAIN OUTCOME MEASURES

Possible predictive factors for mortality as evaluated by application of Fisher's test.

RESULTS

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.

CONCLUSION

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.