Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis

Abstract

Background:Necrotizing fasciitis is a rapidly progressive infection with a high mortality rate. Pathogens evade the host containment and bactericidal mechanisms by hijacking the coagulation and inflammation signaling pathways, leading to their rapid dissemination, thrombosis, organ dysfunction, and death. This study examines the hypothesis that measures of immunocoagulopathy upon admission could aid in the identification of patients with necrotizing fasciitis at high risk for in-hospital mortality.Methods:Demographic data, infection characteristics, and laboratory values from 389 confirmed necrotizing fasciitis cases from a single institution were analyzed. A multivariable logistic regression model was built on admission immunocoagulopathy measures (absolute neutrophil, absolute lymphocyte, and platelet counts) and patient age to predict in-hospital mortality.Results:The overall in-hospital mortality rate was 19.8% for the 389 cases and 14.6% for the 261 cases with complete measures of immunocoagulopathy on admission. A multivariable logistic regression model indicated that platelet count was the most important predictor of mortality, followed by age and absolute neutrophil count. Greater age, higher neutrophil count, and lower platelet count led to significantly higher risk of mortality. The model discriminated well between survivors and non-survivors, with an overfitting-corrected C-index of 0.806.Conclusions:This study determined that measures of immunocoagulopathy and patient age at admission effectively prognosticated the in-hospital mortality risk of patients with necrotizing fasciitis. Given the accessibility of neutrophil-to-lymphocyte ratio and platelet count measurements determined from a simple complete blood-cell count with differential, future prospective studies examining the utility of these measures are warranted.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Is Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio or Red Blood Cell Distribution Width Associated with Risk of Mortality in Patients with Necrotizing Fasciitis

“…NLR/PLR in relation to adverse outcomes (morbidity and mortality) has been studied repeatedly in a variety of settings, including cancer, chronic/acute medical conditions or trauma. 7 , 10 , 11 , 16 , 17 However, specifying at NF, there were only two studies evaluating the utility of NLR/PLR: Ravindhran et al 18 suggested that a preoperative NLR of >7.5, but not PLR, significantly increased the risk of morbidity/mortality, and Johnson et al 26 found a moderate correlation of NLR with in-hospital mortality, which could be further improved by evaluating the ratio of NLR to platelet count. Our findings showed that both NLR and PLR were independently associated with mortality in patients with NF, confirming this relationship.…”