Department of Surgery, Traumasurgery, Medical Spectrum Twente, Koningsstraat 1, 7512 KZ, Enschede, The Netherlands.
Department of Surgery, Traumasurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1189-1195. doi: 10.1007/s00068-021-01706-z. Epub 2021 May 27.
Necrotizing fasciitis (NF) is a severe soft tissue infection with a high morbidity and mortality. With early diagnosis and treatment this could be reduced. Unfortunately, the diagnosis of necrotizing fasciitis can be very difficult. In recent years many risk factors have been identified. In 2004, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed. A tool that could help diagnosing NF. In this study, we search for prognostic factors for mortality in necrotizing fasciitis.
All adult patients with histopathological or surgical confirmed NF needed to be admitted to the intensive care unit for at least 24 h between January 2003 and December 2017 in five hospitals from the Nijmegen teaching region were included. We excluded patients with other forms of soft tissue infections or patients with an intensive care unit (ICU) stay of < 24 h because we exclusively wanted to include patients with a fulminant course of necrotizing fasciitis.
We have included 123 cases. The overall mortality was 31.7% (N = 39). The overall mean LRINEC score was 7.4 ± 2.7. Patients who died as the result of NF had a significantly higher median LRINEC score (8 vs. 7, p = 0.034). Other parameters found to be associated with mortality are age ≥ 60 years, cardiovascular disease in the medical history, ≥ 2 comorbidities, and lactate level greater than 1.7 mmol/L.
LRINEC score should be calculated in all patients presenting with NF to provide an additional source for clinical outcome. A high LRINEC score could implicate a higher risk of mortality. Especially in elderly patients, with a cardiac history, more than two comorbidities or a lactate level greater than 1.7 mmol/L.
坏死性筋膜炎（NF）是一种严重的软组织感染，具有较高的发病率和死亡率。通过早期诊断和治疗，可以降低这种发病率和死亡率。不幸的是，NF 的诊断可能非常困难。近年来，已经确定了许多危险因素。2004 年，开发了实验室风险指标坏死性筋膜炎（LRINEC）评分，这是一种有助于诊断 NF 的工具。在这项研究中，我们寻找 NF 患者死亡的预后因素。
在 2003 年 1 月至 2017 年 12 月期间，5 家奈梅亨教学医院的重症监护病房收治了至少 24 小时的组织病理学或手术证实的 NF 成年患者。我们排除了其他形式的软组织感染患者或 ICU 入住时间<24 小时的患者，因为我们专门想包括 NF 暴发性病程的患者。
我们共纳入了 123 例患者。总体死亡率为 31.7%（N=39）。总的平均 LRINEC 评分为 7.4±2.7。因 NF 死亡的患者的中位 LRINEC 评分明显较高（8 分比 7 分，p=0.034）。与死亡率相关的其他参数是年龄≥60 岁、既往有心血管疾病、≥2 种合并症和乳酸水平大于 1.7mmol/L。
在所有出现 NF 的患者中都应计算 LRINEC 评分，为临床预后提供额外的依据。LRINEC 评分高可能意味着死亡率更高。特别是在老年患者、有心脏病史、有两种以上合并症或乳酸水平大于 1.7mmol/L 的患者中。
