Hitoshi Suzuki1, Keiji Muramatsu2, Tatsuhiko Kubo3, Makoto Kawasaki4, Teruaki Fujitani5, Manabu Tsukamoto6, Soshi Uchida7, Yoshihisa Fujino8, Shinya Matsuda9, Akinori Sakai1. 1. Department of Orthopedics, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi, Kitakyushu 8078555, Japan. Electronic address: belltree@med.uoeh-u.ac.jp. 2. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi, Kitakyushu 8078555, Japan. Electronic address: km@med.uoeh-u.ac.jp. 3. Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences,Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 7340037, Japan. Electronic address: kubo@med.uoeh-u.ac.jp. 4. Department of Orthopedics, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi, Kitakyushu 8078555, Japan. Electronic address: k-makoto@med.uoeh-u.ac.jp. 5. Department of Orthopedics, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi, Kitakyushu 8078555, Japan. Electronic address: fujitani@med.uoeh-u.ac.jp. 6. Department of Orthopedics, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi, Kitakyushu 8078555, Japan. Electronic address: m-tsuka@med.uoeh-u.ac.jp. 7. Department of Orthopedics, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan, 1-17-1, Hamamachi, Wakamatsu, Kitakyushu 8080024, Japan. Electronic address: soushi@med.uoeh-u.ac.jp. 8. Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi, Kitakyushu 8078555, Japan. Electronic address: zenq@med.uoeh-u.ac.jp. 9. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi, Kitakyushu 8078555, Japan. Electronic address: smatsuda@med.uoeh-u.ac.jp.
Abstract
OBJECTIVE: This study aimed to determine the factors associated with mortality among patients with necrotizing soft-tissue infection (NSTI) in Japan using inpatient data from the Diagnosis Procedure Combination (DPC) Database. METHODS: We conducted a cross-sectional study using a population retrieved from the Japanese DPC inpatient database of patients who underwent surgical operations from 2014 through 2017. The associations between the covariates and mortality were estimated using multivariate logistic regression models. RESULTS: In total, 4597 patients were registered in this study, with an overall mortality rate of 6.9%. Multilevel logistic regression analysis revealed that higher age, lower body mass index (BMI<18.5kg/m2), pre-existing cancer diagnosis, sepsis at admission, maintenance dialysis, antithrombin III use, and anti-methicillin-resistant Staphylococcus aureus (MRSA) antibiotic use were associated with a high mortality rate among NSTI patients. However, sex, underlying diabetes mellitus, ambulance use at admission, intravenous immunoglobulin use, higher hospital case volume, and frequency of operations were not associated with mortality. CONCLUSION: This study is the first to report the association of lower BMI, antithrombin III use, and anti-MRSA antibiotic use with a higher mortality rate among NSTI patients.
OBJECTIVE: This study aimed to determine the factors associated with mortality among patients with necrotizing soft-tissue infection (NSTI) in Japan using inpatient data from the Diagnosis Procedure Combination (DPC) Database. METHODS: We conducted a cross-sectional study using a population retrieved from the Japanese DPC inpatient database of patients who underwent surgical operations from 2014 through 2017. The associations between the covariates and mortality were estimated using multivariate logistic regression models. RESULTS: In total, 4597 patients were registered in this study, with an overall mortality rate of 6.9%. Multilevel logistic regression analysis revealed that higher age, lower body mass index (BMI<18.5kg/m2), pre-existing cancer diagnosis, sepsis at admission, maintenance dialysis, antithrombin III use, and anti-methicillin-resistant Staphylococcus aureus (MRSA) antibiotic use were associated with a high mortality rate among NSTI patients. However, sex, underlying diabetes mellitus, ambulance use at admission, intravenous immunoglobulin use, higher hospital case volume, and frequency of operations were not associated with mortality. CONCLUSION: This study is the first to report the association of lower BMI, antithrombin III use, and anti-MRSA antibiotic use with a higher mortality rate among NSTI patients.