Abstract:

Objective

To summarize the clinical characteristics of 66 patients with necrotizing fasciitis （NF） and analyze the factors influencing prognosis.

Methods

A retrospective analysis was performed on the clinical data of 66 NF patients admitted to the Department of Trauma Repair， Burns and Plastic Surgery， Liuzhou Workers' Hospital from January 2017 to December 2023 to summarize the disease characteristics.Clinical factors between the patients with good and poor prognosis were compared， identifed independent risk factors for poor prognosis in NF patients.ROC curves were plotted to evaluate the predictive value of potential independent risk factors for poor prognosis in NF.

Results

Among the 66 patients with NF， there were 52 males and 14 females， with a male-to-female ratio of 3.71 ∶1， the average age was（55.98±13.71） years， patients aged 50 to 70 years accounted for 59.09%， ethnic minority patients account for 53.03%， the average hospital stay was 40.50 （27.75，55.00） days， and the medical costs was 79 976.00（60 676.75， 122 300.25） yuan.The majority of wounds were located in the lower limbs （84.85%）.Diabetes was the main pathogenic factor （59.09%）， the amputation rate was 15.15% and the mortality rate was 3.03%.A total of 77 bacterial strains were cultured from the wounds， with Klebsiella pneumoniae being the most common （16.88%）， and drug-resistant strains accounting for 22.08%.The laboratory risk indicator for necrotizing fasciitis （LRINEC） score was 8.00 （5.75，9.00）， and the inflammation spread range （ISR）score was 1 （1，2）.The LRINEC score in the poor prognosis patients was significantly higher than that in the good prognosis patients （Z=-2.341， P=0.019）， and LRINEC score was an independent risk factor for poor prognosis in NF patients （OR=1.373， 95%CI：1.022-1.844， P=0.035）.The ROC curve showed that the area under the curve for LRINEC score predicting poor prognosis in NF was 0.723 （95%CI：0.546-0.900，P=0.020）.The optimal cutoff value was 7.5， with a sensitivity of 81.8% and a specificity of 54.5%.

Conclusion

Middle-aged and elderly men with diabetes are more susceptible to NF， which commonly affects the lower limbs， with Klebsiella pneumoniae being the most common strain.The LRINEC score is an independent risk factor for poor prognosis in NF patients and has certain predictive value for poor prognosis.LRINEC score greater than or equal to 7.5 indicates poor prognosis in NF patients.

Key words: Necrotizing fasciitis, Prognosis, Laboratory risk indicator for necrotizing fasciitis score, ROC curve analysis