Predictors of Mortality in Necrotizing fasciitis in Sisaket Hospital

Abstract

Necrotizing fasciitis could progress rapidly in soft tissue infection and it was potentially lifethreatening with high mortality rate (10-20%) in Sisaket Hospital. The aim of this study was to identify predictors of mortality based on data available at the initial assessment to stratify prognosis of the according to their risk of death. This was a Retrospective study of 314 patients admitted with necrotizing fasciitis in Sisaket Hospital during 1 January 2008 - 31 January 2010. Patients were separated into 2 groups; Group I : 42 non-survived patients and Group II : 272 survived patients. This study used t-test for continuous variables and then the chi-square test was used to identify variables strongly associated with death. This research revealed the following factors are associated with mortality : Metabolic acidosis; tachycardia; hypotension(p<0.05), higher creatinine(p<0.001), Age>70(OR=2.5, 95%CI=1.3-4.9), site of infection (upper extremity(OR=3.5, 95%CI=1.54-8.17) and perineum(OR=6.7, 95%CI= 0.93-49.27)),body temperature<36.5 c(OR=16.5,95%CI=6.3-42.7), Hct<30(OR=2.0, 95%CI=1.06-3.94), WBC<4000(OR=17.9, 95%CI=4.4-72.5), platelete<100,000(OR=5.4,95%CI= 2.1-13.6), asso ciated condition of CRF(OR=3.88, 95%CI=1.7-5.0), Scr>2.0(OR=12.4, 95%CI=5.6-27.3) and HCO3<20(OR=7.6, 95%CI=3.6-16.3). This study demonstated that site of infection(upper extremity, perineum), hypotension, shock, hypothermia, anemia, leucopenia, thrombocytopenia, metabolic acidosis and associated condition of chronic renal failure were significant risk factor for mortality in necrotizing fasciitis patients.