İrmak Fatih, Karsidag Semra
Department of Plastic, Reconstructive and Aesthetic Surgery, Health Sciences University, Şişli Hamidiye Etfal Application and Research Center, İstanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2019 Feb 4;53(1):27-32. doi: 10.14744/SEMB.2019.57778. eCollection 2019.
Necrotizing fasciitis (NF) is a rare but limb- and life-threatening soft-tissue infection. It is among the most challenging surgical infections faced by surgeons, and is often accompanied by severe systemic toxicity. The aim of this study was to evaluate the predictive power of serum lactate and creatinine levels for mortality and morbidity in lower extremity NF.
A retrospective cohort analysis of 87 patients with lower extremity NF was performed to evaluate the management techniques and the amputation and survival rates according to serum lactate and creatinine levels as well as the time between the onset of symptoms and surgery.
The mean time between the onset of symptoms and surgery was 3.7 days. As the time between the onset of symptoms and surgery increased, the rate of amputation and mortality significantly increased (p<0.001). In all, 66% of the mortality in the group was seen among the 12 patients who had a serum creatinine level greater than 2 mg/dL at the time of presentation. In 12 of 14 patients (85.7%) who underwent amputation/disarticulation, the mean serum lactate level was 5.7 mmol/L (range: 5.1-8.7 mmol/L), and the mean serum creatinine level was 1.92 mg/dL (range: 1.4 to.3.3 mg/dL). The high levels of serum creatinine and lactate were found to be statistically significant in terms of predicting mortality and amputation (p<0.001).
Based on the results of this study, it was determined that risk factors for mortality include age, late presentation, increased serum creatinine and lactate levels, and that these factors can predict the rate of death from NF at the time of presentation.
坏死性筋膜炎（NF）是一种罕见但会危及肢体和生命的软组织感染。它是外科医生面临的最具挑战性的外科感染之一，常伴有严重的全身毒性。本研究的目的是评估血清乳酸和肌酐水平对下肢坏死性筋膜炎患者死亡率和发病率的预测能力。
对87例下肢坏死性筋膜炎患者进行回顾性队列分析，以评估治疗技术、根据血清乳酸和肌酐水平以及症状出现至手术的时间计算的截肢率和生存率。
症状出现至手术的平均时间为3.7天。随着症状出现至手术时间的增加，截肢率和死亡率显著增加（p<0.001）。总体而言，该组66%的死亡病例出现在就诊时血清肌酐水平大于2mg/dL的12例患者中。在接受截肢/关节离断术的14例患者中的12例（85.7%）中，血清乳酸平均水平为5.7mmol/L（范围：5.1 - 8.7mmol/L），血清肌酐平均水平为1.92mg/dL（范围：1.4至3.3mg/dL）。血清肌酐和乳酸水平升高在预测死亡率和截肢方面具有统计学意义（p<0.001）。
基于本研究结果，确定死亡率的危险因素包括年龄、就诊延迟、血清肌酐和乳酸水平升高，并且这些因素可以在就诊时预测坏死性筋膜炎的死亡率。
