Nobuhiro Asai1, Wataru Ohashi2, Takaaki Kishino3, Daisuke Sakanashi4, Yuichi Shibata5, Hideo Kato6, Arufumi Shiota4, Mao Hagihara7, Yusuke Koizumi1, Yuka Yamagishi1, Hiroyuki Suematsu4, Hiroshige Mikamo8. 1. Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan. 2. Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital, Japan. 3. Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Emergency and Critical Care Medicine, Aichi Medical University Hospital, Japan. 4. Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan. 5. Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan. 6. Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia. 7. Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Aichi, Japan. 8. Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan. Electronic address: mikamo@aichi-med-u.ac.jp.
Abstract
INTRODUCTION: While necrotizing fasciitis (NF) is a rare but rapidly progressive devastating soft tissue infectious disease showing a high in-hospital mortality rate of 20-30%, there are no evidence-based predictive tools. PATIENTS AND METHODS: For the purpose of examining which predictive tools could correctly reflect the severity and prognosis of NF, we retrospectively reviewed all patients who were diagnosed with NF at our institute. The disease severity was evaluated by quick SOFA (qSOFA), SOFA score, SIRS score, APACHE II score, LRINEC score and the combined score of qSOFA and CCI. RESULTS: A total of 27 patients were enrolled in this study. The median age was 68 years (range 39-96 years). With respect to the predictive values for in-hospital mortality among NF patients, the area under the ROC curve for qSOFA, SOFA score, APACHE II score, the combined score of qSOFA and CCI were 0.653 (p = 0.192), 0.588 (p = 0.12), 0.709 (p = 0.075) and 0.782 (p = 0.016) respectively. A univariate analysis showed that the combined score of qSOFA and CCI≥5 and the initial treatment failure were poor prognostic indicators for the in-hospital death among NF patients. The appropriate cut-offs of qSOFA and CCI were based on the Youden Index. CONCLUSION: We concluded that the combined score of qSOFA and CCI could reflect the severity and prognosis of NF for in-hospital death.
INTRODUCTION: While necrotizing fasciitis (NF) is a rare but rapidly progressive devastating soft tissue infectious disease showing a high in-hospital mortality rate of 20-30%, there are no evidence-based predictive tools. PATIENTS AND METHODS: For the purpose of examining which predictive tools could correctly reflect the severity and prognosis of NF, we retrospectively reviewed all patients who were diagnosed with NF at our institute. The disease severity was evaluated by quick SOFA (qSOFA), SOFA score, SIRS score, APACHE II score, LRINEC score and the combined score of qSOFA and CCI. RESULTS: A total of 27 patients were enrolled in this study. The median age was 68 years (range 39-96 years). With respect to the predictive values for in-hospital mortality among NF patients, the area under the ROC curve for qSOFA, SOFA score, APACHE II score, the combined score of qSOFA and CCI were 0.653 (p = 0.192), 0.588 (p = 0.12), 0.709 (p = 0.075) and 0.782 (p = 0.016) respectively. A univariate analysis showed that the combined score of qSOFA and CCI≥5 and the initial treatment failure were poor prognostic indicators for the in-hospital death among NF patients. The appropriate cut-offs of qSOFA and CCI were based on the Youden Index. CONCLUSION: We concluded that the combined score of qSOFA and CCI could reflect the severity and prognosis of NF for in-hospital death.