Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis
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, an...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2023-03-01
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| Series: | JBJS Open Access |
| Online Access: | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00106 |
| _version_ | 1797859612361228288 |
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| author | Samuel R. Johnson, BS Teresa Benvenuti, BA Hui Nian, PhD Isaac P. Thomson, MD, MSCI Keith Baldwin, MD, MPH, MSPT William T. Obremskey, MD, MPH, MMHC Jonathan G. Schoenecker, MD, PhD Stephanie N. Moore-Lotridge, PhD |
| author_facet | Samuel R. Johnson, BS Teresa Benvenuti, BA Hui Nian, PhD Isaac P. Thomson, MD, MSCI Keith Baldwin, MD, MPH, MSPT William T. Obremskey, MD, MPH, MMHC Jonathan G. Schoenecker, MD, PhD Stephanie N. Moore-Lotridge, PhD |
| author_sort | Samuel R. Johnson, BS |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T21:32:21Z |
| format | Article |
| id | doaj.art-403e783e9e6d44629acb7627a59a1c36 |
| institution | Directory Open Access Journal |
| issn | 2472-7245 |
| language | English |
| last_indexed | 2024-04-09T21:32:21Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | JBJS Open Access |
| spelling | doaj.art-403e783e9e6d44629acb7627a59a1c362023-03-27T06:48:38ZengWolters KluwerJBJS Open Access2472-72452023-03-018110.2106/JBJS.OA.22.00106JBJSOA2200106Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing FasciitisSamuel R. Johnson, BS0Teresa Benvenuti, BA1Hui Nian, PhD2Isaac P. Thomson, MD, MSCI3Keith Baldwin, MD, MPH, MSPT4William T. Obremskey, MD, MPH, MMHC5Jonathan G. Schoenecker, MD, PhD6Stephanie N. Moore-Lotridge, PhD71 Vanderbilt University School of Medicine, Nashville, Tennessee2 Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee3 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee4 Division of Infectious Disease, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee6 Department of Orthopaedics, The Children’s Hospital of Pennsylvania, Philadelphia, Pennsylvania2 Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee2 Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee2 Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TennesseeBackground:. 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.http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00106 |
| spellingShingle | Samuel R. Johnson, BS Teresa Benvenuti, BA Hui Nian, PhD Isaac P. Thomson, MD, MSCI Keith Baldwin, MD, MPH, MSPT William T. Obremskey, MD, MPH, MMHC Jonathan G. Schoenecker, MD, PhD Stephanie N. Moore-Lotridge, PhD Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis JBJS Open Access |
| title | Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis |
| title_full | Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis |
| title_fullStr | Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis |
| title_full_unstemmed | Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis |
| title_short | Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis |
| title_sort | measures of admission immunocoagulopathy as an indicator for in hospital mortality in patients with necrotizing fasciitis |
| url | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.22.00106 |
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