Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Atrium Health, Charlotte, North Carolina, USA.
Surg Infect (Larchmt). 2022 Apr;23(3):304-312. doi: 10.1089/sur.2021.317. Epub 2022 Feb 21.
Necrotizing soft tissue infections (NSTIs) are severe, rapidly spreading infections with high morbidity and mortality. Attempts to identify risk factors for mortality and morbidity have produced variable results. We hope to determine which factors across the NSTI population impact mortality, morbidities, and discharge disposition. Retrospective data from the National Inpatient Sample from 2012-2018 of patients with primary diagnosis of NSTI (gas gangrene, necrotizing faciitis, cutaneous gangrene, or Fournier gangrene) were identified for analysis. A 1:4 greedy match was performed and risk factors for in-hospital mortality and discharge disposition were examined. Continuous variables were assessed using t-tests and Wilcoxon rank sum tests. Categorical variables were assessed using χ and Fisher exact tests. Statistical significance was defined as p < 0.05. A total of 6,608 patients were identified. Weighted, this represents 33,040 patients; 32,390 are in the no-mortality cohort and 650 in the mortality cohort. Advanced age group was a risk factor for both in-hospital mortality and morbidity, but not for discharge to a skilled nursing or rehabilitation facility. Having two or more comorbidities was a risk factor for mortality, morbidity, and discharge to skilled nursing or rehabilitation facility. Cancer, liver disease, and kidney disease were predictors of in-hospital mortality. Diabetes mellitus and kidney disease were predictors of experiencing an in-hospital complication. Diabetes mellitus, heart disease, and kidney disease were predictors for discharge to skilled nursing or rehabilitation facility. Necrotizing soft tissue infections are associated with substantial morbidity and mortality. Identifying patients at higher risk for mortality, morbidity, and higher level of care at discharge can help providers properly allocate resources to improve patient outcomes and reduce the financial burden on patients and healthcare facilities. Special attention should be paid to those with existing or acute kidney dysfunction because this was the only comorbidity associated with increased risk mortality, morbidity, and discharge to higher level of care.
坏死性软组织感染（NSTIs）是一种严重的、迅速扩散的感染，发病率和死亡率都很高。尝试确定死亡率和发病率的危险因素得出了不同的结果。我们希望确定 NSTI 患者人群中的哪些因素会影响死亡率、发病率和出院情况。
对 2012 年至 2018 年国家住院患者样本中患有原发性 NSTI（气性坏疽、坏死性筋膜炎、皮肤坏疽或 Fournier 坏疽）的患者进行了回顾性数据分析。进行了 1:4 的贪婪匹配，并检查了住院死亡率和出院处置的危险因素。使用 t 检验和 Wilcoxon 秩和检验评估连续变量。使用 χ 和 Fisher 确切检验评估分类变量。统计显著性定义为 p < 0.05。
共确定了 6608 名患者。加权后，这代表了 33040 名患者；32390 名患者在无死亡率队列中，650 名患者在死亡率队列中。高龄是住院死亡率和发病率的危险因素，但不是向熟练护理或康复机构出院的危险因素。有两种或两种以上合并症是死亡、发病和向熟练护理或康复机构出院的危险因素。癌症、肝病和肾病是住院死亡率的预测因素。糖尿病和肾病是住院并发症的预测因素。糖尿病、心脏病和肾病是向熟练护理或康复机构出院的预测因素。
坏死性软组织感染与较高的发病率和死亡率相关。识别出死亡率、发病率和出院后护理水平较高的患者，有助于提供者合理分配资源，改善患者预后，减轻患者和医疗机构的经济负担。应特别注意那些有现有或急性肾功能障碍的患者，因为这是唯一与死亡率、发病率和向更高水平护理出院风险增加相关的合并症。
