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. 2019 Apr-Jun;12(2):108-116.
doi: 10.4103/JETS.JETS_17_18.

Factors Affecting Mortality Following Necrotizing Soft-Tissue Infections: Randomized Prospective Study

Sukha Ram Barupal  1 , Murari Lal Soni  2 , Rekha Barupal  3
Affiliations

Factors Affecting Mortality Following Necrotizing Soft-Tissue Infections: Randomized Prospective Study

Sukha Ram Barupal et al. J Emerg Trauma Shock. 2019 Apr-Jun.

Abstract

Background and aim: Necrotizing soft-tissue infections (NSTIs) are common in the Indian subcontinent and are associated with high morbidity and mortality. The aim of this paper was to correlate clinical factors and Acute Physiology Health and Chronic Health Evaluation (APACHE) II score with mortality following NSTI.

Methodology: Patients presenting to our tertiary-care center between November 1, 2014, and December 1, 2016, with NSTI and between the age of 15 and 90 years were included and entered into a prospectively maintained database. Fifty random patients were selected from the database and were divided according to the survival outcome into two groups: Group 1-survivors and Group 2-nonsurvivors. The two groups were compared for clinical factors and APACHE II score to identify the variable which correlated with the survival.

Results: Mean age of the study cohort (n = 50, 44 males) was 50.8 ± 17.1 years. Fournier's gangrene was the most common manifestation (64%), followed by lower limb (14%). Infection was leading cause (34%) followed by trauma (16%) and prior surgery (14%). There were 16 in-hospital deaths (32%). Two groups were similar regarding age and sex. At presentation, nonsurvival group had significantly higher body surface area involvement (P = 0.001), anemia (P = 0.023), metabolic acidosis (P < 0.0001), serum creatinine (P = 0.007), and mean APACHE II score (P < 0.001). There was no difference between time from presentation to the first debridement.

Conclusions: We found that APACHE II is a significant predictor of mortality. Early diagnosis and prompt aggressive treatment is the only way to improve outcome. Further studies with larger sample size are warranted.

Keywords: Acute Physiology Health and Chronic Health Evaluation II score; Fournier's gangrene; mortality; necrotizing fasciitis; soft-tissue infections.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart depicting study protocol with inclusion and exclusion of patients and division of patients into groups and subgroups
Figure 2
Figure 2
Segregation of patient cohort according to age group
Figure 3
Figure 3
Case of Fournier's gangrene at presentation (a) and after debridement and secondary suturing (b)
See this image and copyright information in PMC

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