Scholarlink

Purpose <p>Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with limited epidemiological data from Latin America. This study aimed to characterize clinical outcomes, identify factors associated with in-hospital mortality, and develop a clinical prediction model in patients with NF at a tertiary care center in Medellín, Colombia.</p> Methods <p>A retrospective cohort study was conducted including all adult patients (≥ 18 years) with surgically or histopathologically confirmed NF between January 2019 and December 2024. Demographic, clinical, microbiological, and therapeutic variables were collected. Bivariable analysis and multivariable logistic regression were performed to identify independent mortality predictors. A clinical risk score was developed and internally validated using bootstrap resampling and 10-fold cross-validation.</p> Results <p>Of 112 identified patients, 111 met inclusion criteria. Overall in-hospital mortality was 23.4% (26/111). Deceased patients were significantly older (median 69.5 vs. 52 years; <i>p</i> &lt; 0.001). Serum lactate demonstrated strong prognostic value (AUC 0.719; 95% CI 0.596–0.842; 2.9 vs. 1.8 mmol/L; <i>p</i> = 0.003). Septic shock was present in 34.2% and doubled mortality risk (34.2% vs. 17.8%; <i>p</i> = 0.060). Polymicrobial infections predominated (74.8%), with a predominantly gram-negative profile and high antimicrobial resistance rates (carbapenemase-producing organisms 19.8%, ESBL 12.6%). Culture-negative infections were strongly associated with mortality (60.0%; OR 6.07, 95% CI 1.56–23.6; <i>p</i> = 0.009). The LRINEC score, designed as a diagnostic tool, did not discriminate mortality (AUROC 0.463), consistent with its diagnostic rather than prognostic design. In multivariable analysis, age (OR 1.07 per year; 95% CI 1.04–1.11; <i>p</i> &lt; 0.001) and immunosuppression (OR 4.06; 95% CI 0.84–19.51; <i>p</i> = 0.073) were retained as predictors. The proposed two-variable exploratory model (age + immunosuppression) demonstrated an AUROC of 0.798 (95% CI 0.713–0.884), with minimal incremental value over an age-only model (AUROC 0.776; ΔAUROC 0.022).</p> Conclusion <p>NF remains highly lethal, with age as the strongest independent prognostic factor and immunosuppression as an exploratory signal; serum lactate and septic shock are key markers of severity.The proposed exploratory score is largely driven by age and offers only modest incremental discrimination over age alone; external multicenter validation is required before any clinical implementation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Risk factors and predictors of in-hospital mortality in necrotizing fasciitis: a five-year retrospective cohort study from a tertiary care center in Colombia

  • 期刊论文

  • 发表日期：

    2026年5月11日

查看全文
  • Mateo Londoño Barrientos,
  • Ana Sofia Ramirez Cordoba,
  • Maria del Mar Luna Valencia,
  • Maria Mercedes Melguizo Valencia,
  • David Alejandro Mejia Toro,
  • Carlos Alberto Lopez Zapata,
  • Carlos Andres Delgado

摘要

Purpose

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with limited epidemiological data from Latin America. This study aimed to characterize clinical outcomes, identify factors associated with in-hospital mortality, and develop a clinical prediction model in patients with NF at a tertiary care center in Medellín, Colombia.

Methods

A retrospective cohort study was conducted including all adult patients (≥ 18 years) with surgically or histopathologically confirmed NF between January 2019 and December 2024. Demographic, clinical, microbiological, and therapeutic variables were collected. Bivariable analysis and multivariable logistic regression were performed to identify independent mortality predictors. A clinical risk score was developed and internally validated using bootstrap resampling and 10-fold cross-validation.

Results

Of 112 identified patients, 111 met inclusion criteria. Overall in-hospital mortality was 23.4% (26/111). Deceased patients were significantly older (median 69.5 vs. 52 years; p < 0.001). Serum lactate demonstrated strong prognostic value (AUC 0.719; 95% CI 0.596–0.842; 2.9 vs. 1.8 mmol/L; p = 0.003). Septic shock was present in 34.2% and doubled mortality risk (34.2% vs. 17.8%; p = 0.060). Polymicrobial infections predominated (74.8%), with a predominantly gram-negative profile and high antimicrobial resistance rates (carbapenemase-producing organisms 19.8%, ESBL 12.6%). Culture-negative infections were strongly associated with mortality (60.0%; OR 6.07, 95% CI 1.56–23.6; p = 0.009). The LRINEC score, designed as a diagnostic tool, did not discriminate mortality (AUROC 0.463), consistent with its diagnostic rather than prognostic design. In multivariable analysis, age (OR 1.07 per year; 95% CI 1.04–1.11; p < 0.001) and immunosuppression (OR 4.06; 95% CI 0.84–19.51; p = 0.073) were retained as predictors. The proposed two-variable exploratory model (age + immunosuppression) demonstrated an AUROC of 0.798 (95% CI 0.713–0.884), with minimal incremental value over an age-only model (AUROC 0.776; ΔAUROC 0.022).

Conclusion

NF remains highly lethal, with age as the strongest independent prognostic factor and immunosuppression as an exploratory signal; serum lactate and septic shock are key markers of severity.The proposed exploratory score is largely driven by age and offers only modest incremental discrimination over age alone; external multicenter validation is required before any clinical implementation.