The Factors Related to Mortality of Patients with Necrotizing Fasciitis at Uthaithani Hospital
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Date
2010-03-10
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Thammasat University, Rangsit Campus
Abstract
Background: Necrotizing fasciitis (NF) is a fatal condition which commonly occurs in patients who have some immunodeficient conditions. The incidence of disease increases in several tropical epidemic areas in Thailand. Main etiology was external punctured wounds. It is frequently found in farmers as reported in this study. Objective: To study risk factors which related to mortality rate of NF. Material and method: A retrospective study was conducted by collecting data from all medical records of the patients undergone surgery for NF in Uthaithani Hospital during October 2002 to September 2008. The data was analyzed by using the statistics of mean, standard deviation, percentage, Chi-square test and independent T-test. Result: There were 137 cases of NF, 67 males, 70 females, mean age 60.7 ± 15.5 years (range 39-96 years) Thirty two cases (23.4%) died, mainly in elderly patients, mean age 67.5 ± 12.2 years. Over all duration of symptoms were 1 to 8 days (3.3 ± 1.8) and length of hospital stays were 2 to 48 days (15.2 ± 12.6). The proportion of each risk factors in dead cases when compared with all cases were diabetes mellitus 19.4% (6/31), cirrhosis 33.3% (2/6), heart diseases 72.7% (8/11), steroid intake 44.4% (8/18), white blood cell count over 20,000 cell/mm³ 42.4% (14/33), blood creatinine over 2 mg/dL 46.1% (12/26), duration of admission times to operation over 12 hours 20.9% (10/43), unsuitable antibiotics usage 25% (3/12), polymicrobial infections 31.8% (14/44), infections to muscular layer 50% (6/12), initially missed diagnosis 40.7% (11/27), shock at initial admission 64.7% (11/17) and limb amputation 33.3% (4/12). Conclusion: The statistic risk factors which were related to mortality of NF were initially missed diagnosis, old age, heart disease and steroid intake. Some factors were found in severe cases upon admission such as or shock, renal and pulmonary insufficiency. Concerning bacterial effects, risk factors were polymicrobial and muscular layer infections. It also revealed that limb amputations and infection to muscular layer were related to diabetic cases. But other factors had no significant relationship to mortality.
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Thammasat Medical Journal - ธรรมศาสตร์เวชสาร; Vol.9 No.2 April-June 2009; 86-93