坏死性皮肤和软组织感染患者入院时死亡率、肢体丧失和出院去向的预测因素。
Predictors of mortality, limb loss, and discharge disposition at admission among patients with necrotizing skin and soft tissue infections.
机构信息
From the Department of Surgery (D.L.H., T.N.W.), University of Washington; University of Washington School of Medicine (J.S., E.R.); Department of Biomedical Informatics (K.S.L.), University of Washington; and Division of Trauma and Critical Care, Department of Surgery (G.E.O., J.C., E.M.B., B.R.H.R.), University of Washington, Harborview Medical Center, Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2020 Jul;89(1):186-191. doi: 10.1097/TA.0000000000002636.
BACKGROUND
Necrotizing soft tissue infections (NSTI) represent a heterogeneous group of rapidly progressive skin and soft tissue infections associated with significant morbidity and mortality. Efforts to identify factors associated with death have produced mixed results, and little or no data is available for other adverse outcomes. We sought to determine whether admission variables were associated with mortality, limb loss, and discharge disposition in patients with NSTI.
METHODS
We analyzed prospectively collected data of adult patients with surgically confirmed NSTI from an NSTI registry maintained at a quaternary referral center. Factors independently associated with mortality, amputation, and skilled nursing facility discharge were identified using logistic regression.
RESULTS
Between 2015 and 2018, 446 patients were identified. The median age was 55 years (interquartile range, 43-62). The majority of patients were male (65%), white (77%), and transferred from another facility (90%). The perineum was most commonly involved (37%), followed by the lower extremity (34%). The median number of operative debridements was 3 (interquartile range, 2-4). Overall mortality was 15%, and 21% of extremity NSTI patients required amputation. Age greater than 60 years; creatinine greater than 2 mg/dL; white blood cell count greater than 30 x 10^ /μl, platelets less than 150 × 10/μL, and clostridial involvement were independently associated with greater odds of death; perineal involvement was associated with lower odds of death. Age greater than 60 years; sex, male; nonwhite race; diabetes; chronic wound as etiology; leg involvement; transfer status; and sodium, less than 130 mEq/L were independently associated with amputation. Age greater than 60 years; sex, female; nonwhite race; perineal involvement; and amputation were associated with skilled care facility discharge.
CONCLUSION
Necrotizing soft tissue infections are a heterogeneous group of infections involving significantly different patient populations with different outcomes; efforts to differentiate and predict adverse outcomes in NSTI should include laboratory data, comorbidities, infection site, and/or etiology to improve predictions and better account for this heterogeneity.
LEVEL OF EVIDENCE
Prognostic, Level III.
背景
坏死性软组织感染（NSTI）是一组异质性迅速进展的皮肤和软组织感染，与显著的发病率和死亡率相关。尽管人们努力识别与死亡相关的因素，但结果喜忧参半，对于其他不良结局，几乎没有或没有可用的数据。我们旨在确定 NSTI 患者的入院变量是否与死亡率、肢体丧失和出院去向相关。
方法
我们分析了在一家四级转诊中心维持的 NSTI 注册处前瞻性收集的成年手术确诊 NSTI 患者的数据。使用逻辑回归确定与死亡率、截肢和熟练护理设施出院独立相关的因素。
结果
在 2015 年至 2018 年期间，共确定了 446 名患者。中位年龄为 55 岁（四分位间距，43-62）。大多数患者为男性（65%）、白人（77%）和从其他医疗机构转来（90%）。最常见的感染部位是会阴（37%），其次是下肢（34%）。中位数手术清创次数为 3 次（四分位间距，2-4）。总体死亡率为 15%，21%的肢体 NSTI 患者需要截肢。年龄大于 60 岁；肌酐大于 2mg/dL；白细胞计数大于 30×10^9/μl、血小板小于 150×10^9/μL 和梭菌感染与更高的死亡几率相关；会阴受累与较低的死亡几率相关。年龄大于 60 岁；男性；非白人种族；糖尿病；慢性伤口作为病因；腿部受累；转院状态；以及钠水平小于 130mEq/L 与截肢独立相关。年龄大于 60 岁；女性；非白人种族；会阴受累；以及截肢与熟练护理设施出院相关。
结论
坏死性软组织感染是一组异质性感染，涉及具有不同结局的不同患者群体；为了区分和预测 NSTI 的不良结局，应包括实验室数据、合并症、感染部位和/或病因，以提高预测准确性并更好地考虑这种异质性。
证据水平
预后，III 级。
Zotero 插件