Pommier Jean-David, Tressieres Benoît, Blanchet Pascal, Desmoulins Frederic, Piednoir Pascale, Aissa Nejla, Martino Frederic, Valette Marc, Demoule Alexandre, Breurec Sebastien, Camous Laurent
Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, 97139, Les Abymes, Guadeloupe, France.
Centre d'Investigation Clinique Antilles-Guyane, Inserm CIC 1424, CHU de Guadeloupe, 97139, Les Abymes, Guadeloupe, France.
Ann Intensive Care. 2025 Jun 2;15(1):77. doi: 10.1186/s13613-025-01488-2.
BACKGROUND: Scarce epidemiological data are available regarding necrotizing soft tissue infections (NSTIs) in tropical areas. Here we aimed to describe the clinical and biological features, and outcomes, of critically ill patients with NSTIs admitted to an intensive care unit (ICU) in a tropical setting. Furthermore, we analyzed these findings to identify distinct clinical phenotypes and explore their associations with patient outcomes. METHODS: This retrospective observational study included all patients with NSTIs admitted to the ICU of the University Hospital of Guadeloupe between January 2014 and December 2023. Subgroups of patients having similar clinical profiles were identified through unsupervised clustering (factor analysis for mixed data, and hierarchical clustering on principal components). Univariate and multivariate analyses identified factors associated with 90-day mortality. RESULTS: During the study period, 91 NSTI patients were admitted to the ICU. The median Simplified Acute Physiology Score (SAPS) II was 45 [IQR 40-66], and the median time between hospital admission and first surgical debridement was 8 h [IQR 6-10 h]. While in the ICU, 65% of patients were mechanically ventilated, 75% experienced shock, and 34% underwent renal replacement therapy. The 90-day mortality rate was 32%. Unsupervised clustering revealed three clusters-mild NSTI (n = 23, 25%), severe NSTI (n = 49, 54%), and fulminant NSTI (n = 19, 21%)-which were associated with different ICU courses and outcomes. Subcutaneous emphysema and sepsis-associated encephalopathy were key components influencing cluster identification. Multivariate analysis revealed that mortality was associated with SAPS II, subcutaneous emphysema, >8 h between hospital admission and first surgery, and immunocompromised status. CONCLUSION: Unsupervised analysis of critically ill patients with NSTIs in tropical settings revealed three distinct patient clusters that exhibited unique phenotypic characteristics and clinical outcomes. Upon hospital admission, patients with NSTIs should be carefully screened for sepsis-associated encephalopathy, subcutaneous emphysema, and thrombopenia. The present exploratory results must be confirmed in larger multicentric cohorts.
背景：关于热带地区坏死性软组织感染（NSTIs）的流行病学数据稀缺。在此，我们旨在描述热带地区重症监护病房（ICU）收治的NSTIs重症患者的临床和生物学特征及预后。此外，我们分析这些结果以识别不同的临床表型，并探讨它们与患者预后的关联。 方法：这项回顾性观察性研究纳入了2014年1月至2023年12月期间瓜德罗普大学医院ICU收治的所有NSTIs患者。通过无监督聚类（混合数据的因子分析和主成分的层次聚类）识别具有相似临床特征的患者亚组。单因素和多因素分析确定与90天死亡率相关的因素。 结果：在研究期间，91例NSTIs患者被收治入ICU。简化急性生理学评分（SAPS）II的中位数为45[四分位间距（IQR）40 - 66]，入院至首次手术清创的中位时间为8小时[IQR 6 - 10小时]。在ICU期间，65%的患者接受机械通气，75%的患者发生休克，34%的患者接受肾脏替代治疗。90天死亡率为32%。无监督聚类揭示了三个集群——轻度NSTI（n = 23，25%）、重度NSTI（n = 49，54%）和暴发性NSTI（n = 19，21%）——它们与不同的ICU病程和预后相关。皮下气肿和脓毒症相关脑病是影响集群识别的关键因素。多因素分析显示，死亡率与SAPS II、皮下气肿、入院至首次手术间隔>8小时以及免疫功能低下状态相关。 结论：对热带地区NSTIs重症患者的无监督分析揭示了三个不同的患者集群，它们表现出独特的表型特征和临床结局。入院时，应对NSTIs患者仔细筛查脓毒症相关脑病、皮下气肿和血小板减少症。目前的探索性结果必须在更大规模的多中心队列中得到证实。
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