Risk Stratification of Necrotizing Fasciitis Based on the Initial Procalcitonin Concentration: A Single Center Observational Study

Al-Thani, Hassan; El‐Menyar, Ayman; Shaikh, Nissar; Mudali, Insolvisagan Natesa; Mekkodathil, Ahammed; Asim, Mohammad; Gameil, Amna; Tabeb, Abdelhakem

doi:10.1089/sur.2014.249

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…Septic shock was defined as sepsis-induced hypotension in terms of systolic blood pressure <90 mmHg or a fall in systolic blood pressure of >40 mmHg that are persisting despite adequate fluid resuscitation. [ 9 10 ]…”

Section: Methodsmentioning

confidence: 99%

Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

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Smith

O'Keeffe

et al. 2016

J Emerg Trauma Shock

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Objectives:Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS.Materials and Methods:Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ2) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis.Results:In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance.Conclusions:Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.

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Section: Methodsmentioning

confidence: 99%

Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

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Smith

O'Keeffe

et al. 2016

J Emerg Trauma Shock

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“…Es importante hacer relevante que de los estudios que conocemos en los que solo se hayan analizado FN de las extremidades, el LRINEC score solo se ha mostrado como una herramienta en la que sus valores altos se encuentran asociados a una mayor estancia hospitalaria , observaron que podía ser utilizada como un marcador de éxito del primer tratamiento quirúrgico en la erradicación de la infección. En nuestro estudio hemos observado que la medición de los niveles de procalcitonina y la categorización del riego mediante la escala utilizada por Al-Thani et al 4 , es mejor herramienta que la escala LRINEC al momento de discriminar entre una FN vs celulitis de las extremidades.…”

Section: Resultsunclassified

“…Además se registraron el número de amputaciones y mortalidad. El riesgo de padecer FN de los pacientes lo categorizamos según el LRINEC [1] en bajo riesgo menor de 6, moderado riesgo: 6-7 y alto riesgo: mayor de 7, y según los niveles de procalcitonina en bajo riesgo <0,5 ng/mL, moderado riesgo ≥0,5-<2 ng/mL, alto riesgo ≥2-<10 ng/mL y muy alto riesgo ≥10 ng/mL [4].…”

Section: Materials Y Métodosunclassified

“…Durante una infección bacteriana, la PCT se produce principalmente por las células de los pulmones y el intestino, y es un marcador confiable en el diagnóstico y tratamiento de infecciones bacterianas graves y sepsis 3 . Al-Thani et al [4] observaron una correlación positiva entre el LRINEC score y los niveles de procalcitonina en la predicción de shock séptico en pacientes con FN. Cabe destacar que ambos trabajos 1,4 no fueron realizados únicamente en pacientes con afectación de las extremidades.…”

Section: Introductionunclassified

“…Al-Thani et al [4] observaron una correlación positiva entre el LRINEC score y los niveles de procalcitonina en la predicción de shock séptico en pacientes con FN. Cabe destacar que ambos trabajos 1,4 no fueron realizados únicamente en pacientes con afectación de las extremidades.…”

Section: Introductionunclassified

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Utilidad de la procalcitonina sérica para la discriminación temprana entre fascitis necrosante y celulitis de las extremidades: serie de casos y revisión de la literatura.

2019

Rev Esp Cir Osteoart

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Objective: to assess the usefulness of a risk scale based on serum procalcitonin when compared with the LRINEC score in the early discrimination between necrotizing fasciitis (NF) and extremities cellulite. Material and method: retrospective study, between 2009 and 2017, of all patients with the confirmed diagnosis of NF in one limb (N = 10). The findings of these patients were compared with those of 23 patients who were admitted for severe cellulitis of limbs in the same period. The variables related to each group were analyzed. Using the area under the curve (AUC), the discrimination capacity for NF diagnosis of two scales was compared, one based on procalcitonin levels and another based on the LRINEC score. Results: the area under the curve was greater for the risk categorized by procalcitonin levels. When analyzing the LRINEC score and procalcitonin levels as continuous variables, the latter also presented a larger area under the curve. The cut-off point with the greatest area under the curve was that corresponding to> 0.87 ng / ml of procalcitonin (sensitivity of 100% and specificity of 82.6%) and score 5 on the LRINEC score (sensitivity of 80% and specificity of 82.6%). Conclusion: in our sample the level of procalcitonin and the scale based on this level has been shown as a more sensitive and at least as specific tool as the LRINEC scale for early discrimination between NF and a cellulite of the extremities.

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The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections

Latifi

Patel

Samson

et al. 2018

Eur J Trauma Emerg Surg

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Risk Stratification of Necrotizing Fasciitis Based on the Initial Procalcitonin Concentration: A Single Center Observational Study

Abstract: Initial procalcitonin concentration in NF carries an important prognostic value and it correlates well with SOFA score and can predict the development of septic shock early in patients with NF.

Cited by 13 publications

References 23 publications

Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

Utilidad de la procalcitonina sérica para la discriminación temprana entre fascitis necrosante y celulitis de las extremidades: serie de casos y revisión de la literatura.

The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections

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