Oud Lavi, Watkins Phillip
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX 79763, USA.
Clinical Research Institute, Texas Tech University HSC, 3601 4th Street, MS6238, Lubbock, TX 79430, USA.
Crit Care Res Pract. 2015;2015:618067. doi: 10.1155/2015/618067. Epub 2015 Mar 29.
Introduction. There are limited population-level reports on the contemporary trends of the epidemiology, clinical features, resource utilization, and outcomes of necrotizing fasciitis (NF). Methods. We conducted a cohort study of Texas inpatient population, identifying hospitalizations with a diagnosis of NF during the years 2001-2010. The incidence, clinical features, resource utilization, and outcomes of NF hospitalizations were examined. Results. There were 12,172 NF hospitalizations during study period, with ICU admission in 50.3%. The incidence of NF rose 2.7%/year (P = 0.0001). Key changes between 2001-2002 and 2009-2010 included rising incidence of NF (5.9 versus 7.6 per 100,000 [P < 0.0001]), chronic comorbidities (69.4% versus 76.7% [P < 0.0001]), and development of ≥1 organ failure (28.5% versus 51.7% [P < 0.0001]). Inflation-adjusted hospital charges rose 37% (P < 0.0001). Hospital mortality (9.3%) remained unchanged during study period. Discharges to long-term care facilities rose from 12.2 to 30% (P < 0.0001). Conclusions. The present cohort of NF is the largest reported to date. There has been increasing incidence, chronic illness, and severity of illness of NF over the past decade, with half of NF hospitalizations admitted to ICU. Hospital mortality remained unchanged, while need for long-term care rose nearly 2.5-fold among survivors, suggesting increasing residual morbidity. The sources of the observed findings require further study.
引言。关于坏死性筋膜炎（NF）的流行病学、临床特征、资源利用及预后的当代趋势，在人群层面的报告有限。方法。我们对德克萨斯州住院患者群体进行了一项队列研究，确定了2001年至2010年间诊断为NF的住院病例。对NF住院病例的发病率、临床特征、资源利用及预后进行了检查。结果。研究期间有12172例NF住院病例，其中50.3%入住重症监护病房（ICU）。NF的发病率以每年2.7%的速度上升（P = 0.0001）。2001 - 2002年与2009 - 2010年之间的主要变化包括NF发病率上升（从每10万人中5.9例升至7.6例[P < 0.0001]）、慢性合并症增加（从69.4%升至76.7%[P < 0.0001]）以及出现≥1种器官功能衰竭的情况增加（从28.5%升至51.7%[P < 0.0001]）。经通胀调整后的住院费用上涨了37%（P < 0.0001）。研究期间医院死亡率（9.3%）保持不变。转至长期护理机构的出院率从12.2%升至30%（P < 0.0001）。结论。目前报道的NF队列是迄今为止最大的。在过去十年中，NF的发病率、慢性病情况及疾病严重程度均有所增加，NF住院病例中有一半入住ICU。医院死亡率保持不变，而幸存者中对长期护理的需求增加了近2.5倍，这表明残余发病率在上升。观察结果的来源需要进一步研究。
