以入院时免疫凝血病作为坏死性筋膜炎患者院内死亡率指标的研究：一项回顾性研究
Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis: A Retrospective Study.
作者信息
Johnson Samuel R, Benvenuti Teresa, Nian Hui, Thomson Isaac P, Baldwin Keith, Obremskey William T, Schoenecker Jonathan G, Moore-Lotridge Stephanie N
机构信息
Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
JB JS Open Access. 2023 Feb 28;8(1). doi: 10.2106/JBJS.OA.22.00106. eCollection 2023 Jan-Mar.
UNLABELLED
Necrotizing fasciitis is a rapidly progressive infection with a high mortality rate. Pathogens evade the host containment and bactericidal mechanisms by hijacking the coagulation and inflammation signaling pathways, leading to their rapid dissemination, thrombosis, organ dysfunction, and death. This study examines the hypothesis that measures of immunocoagulopathy upon admission could aid in the identification of patients with necrotizing fasciitis at high risk for in-hospital mortality.
METHODS
Demographic data, infection characteristics, and laboratory values from 389 confirmed necrotizing fasciitis cases from a single institution were analyzed. A multivariable logistic regression model was built on admission immunocoagulopathy measures (absolute neutrophil, absolute lymphocyte, and platelet counts) and patient age to predict in-hospital mortality.
RESULTS
The overall in-hospital mortality rate was 19.8% for the 389 cases and 14.6% for the 261 cases with complete measures of immunocoagulopathy on admission. A multivariable logistic regression model indicated that platelet count was the most important predictor of mortality, followed by age and absolute neutrophil count. Greater age, higher neutrophil count, and lower platelet count led to significantly higher risk of mortality. The model discriminated well between survivors and non-survivors, with an overfitting-corrected C-index of 0.806.
CONCLUSIONS
This study determined that measures of immunocoagulopathy and patient age at admission effectively prognosticated the in-hospital mortality risk of patients with necrotizing fasciitis. Given the accessibility of neutrophil-to-lymphocyte ratio and platelet count measurements determined from a simple complete blood-cell count with differential, future prospective studies examining the utility of these measures are warranted.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
未标注
坏死性筋膜炎是一种进展迅速、死亡率高的感染性疾病。病原体通过劫持凝血和炎症信号通路来逃避宿主的控制和杀菌机制，从而导致其迅速扩散、血栓形成、器官功能障碍和死亡。本研究检验了这样一个假设，即入院时免疫凝血病的指标有助于识别坏死性筋膜炎患者的院内死亡高风险。
方法
分析了来自单一机构的389例确诊坏死性筋膜炎病例的人口统计学数据、感染特征和实验室值。基于入院时的免疫凝血病指标（绝对中性粒细胞、绝对淋巴细胞和血小板计数）和患者年龄建立多变量逻辑回归模型，以预测院内死亡率。
结果
389例患者的总体院内死亡率为19.8%，入院时免疫凝血病指标完整的261例患者的死亡率为14.6%。多变量逻辑回归模型表明，血小板计数是死亡率的最重要预测指标，其次是年龄和绝对中性粒细胞计数。年龄越大、中性粒细胞计数越高和血小板计数越低，导致死亡风险显著越高。该模型在幸存者和非幸存者之间具有良好的区分能力，经过度拟合校正后的C指数为0.806。
结论
本研究确定，入院时的免疫凝血病指标和患者年龄可有效预测坏死性筋膜炎患者的院内死亡风险。鉴于通过简单的全血细胞计数及分类就能获得中性粒细胞与淋巴细胞比值和血小板计数测量值，未来有必要开展前瞻性研究来检验这些指标的效用。
证据水平
预后III级。有关证据水平的完整描述，请参阅作者指南。
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