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Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand
BACKGROUND: Necrotizing fasciitis (NF) is a life-threatening infection of skin and fascia. Its progress is extremely fast, with extensive necrosis. Delay in treatment, with subsequent huge soft tissue loss and associated severe sepsis, remains a major cause of death in the management of NF. OBJECTIV...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509542/ https://www.ncbi.nlm.nih.gov/pubmed/26213473 http://dx.doi.org/10.2147/IDR.S85249 |
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author | Khamnuan, Patcharin Chongruksut, Wilaiwan Jearwattanakanok, Kijja Patumanond, Jayanton Tantraworasin, Apichat |
author_facet | Khamnuan, Patcharin Chongruksut, Wilaiwan Jearwattanakanok, Kijja Patumanond, Jayanton Tantraworasin, Apichat |
author_sort | Khamnuan, Patcharin |
collection | PubMed |
description | BACKGROUND: Necrotizing fasciitis (NF) is a life-threatening infection of skin and fascia. Its progress is extremely fast, with extensive necrosis. Delay in treatment, with subsequent huge soft tissue loss and associated severe sepsis, remains a major cause of death in the management of NF. OBJECTIVE: The aim of this study was to explore clinical characteristics that may be used to predict severe sepsis in patients with NF, in the context of routine clinical practice in northern Thailand. METHODS: A retrospective observational cohort study was conducted. The patient cohort in this study consisted of all patients who were diagnosed with NF by surgical or pathological confirmation. The follow-up period started with the admission date and ended with the discharge date. The clinical variables were collected from patients registered at three provincial hospitals in northern Thailand from 2009 to 2012. The clinical predictors for severe sepsis were analyzed using multivariable risk regression. RESULTS: A total of 1,452 patients were diagnosed with NF, either with severe sepsis (n=237 [16.3%]) or without severe sepsis (n=1,215 [83.7%]). From the multivariable analysis, female sex (relative risk [RR] =1.51; 95% confidence interval [CI] =1.04–2.20), diabetes mellitus (RR =1.40; 95% CI =1.25–1.58), chronic heart disease (RR =1.31; 95% CI =1.15–1.49), hemorrhagic bleb (RR =1.47; 95% CI =1.32–1.63), skin necrosis (RR =1.45; 95% CI =1.34–1.57), and serum protein <6 g/dL (RR =2.67; 95% CI =1.60–4.47) were all predictive factors for severe sepsis. CONCLUSION: The clinical predictors for severe sepsis in patients with suspicion of NF included female sex, diabetes mellitus, chronic heart disease, hemorrhagic bleb, skin necrosis, and serum protein <6 d/dL. The risk ratio was much higher in patients with total protein less than 6 g/dL, which is associated with malnutrition. Therefore, provision of sufficient nutritional support and close monitoring for these clinical predictors may be beneficial to reduce morbidity and mortality. |
format | Online Article Text |
id | pubmed-4509542 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-45095422015-07-24 Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand Khamnuan, Patcharin Chongruksut, Wilaiwan Jearwattanakanok, Kijja Patumanond, Jayanton Tantraworasin, Apichat Infect Drug Resist Original Research BACKGROUND: Necrotizing fasciitis (NF) is a life-threatening infection of skin and fascia. Its progress is extremely fast, with extensive necrosis. Delay in treatment, with subsequent huge soft tissue loss and associated severe sepsis, remains a major cause of death in the management of NF. OBJECTIVE: The aim of this study was to explore clinical characteristics that may be used to predict severe sepsis in patients with NF, in the context of routine clinical practice in northern Thailand. METHODS: A retrospective observational cohort study was conducted. The patient cohort in this study consisted of all patients who were diagnosed with NF by surgical or pathological confirmation. The follow-up period started with the admission date and ended with the discharge date. The clinical variables were collected from patients registered at three provincial hospitals in northern Thailand from 2009 to 2012. The clinical predictors for severe sepsis were analyzed using multivariable risk regression. RESULTS: A total of 1,452 patients were diagnosed with NF, either with severe sepsis (n=237 [16.3%]) or without severe sepsis (n=1,215 [83.7%]). From the multivariable analysis, female sex (relative risk [RR] =1.51; 95% confidence interval [CI] =1.04–2.20), diabetes mellitus (RR =1.40; 95% CI =1.25–1.58), chronic heart disease (RR =1.31; 95% CI =1.15–1.49), hemorrhagic bleb (RR =1.47; 95% CI =1.32–1.63), skin necrosis (RR =1.45; 95% CI =1.34–1.57), and serum protein <6 g/dL (RR =2.67; 95% CI =1.60–4.47) were all predictive factors for severe sepsis. CONCLUSION: The clinical predictors for severe sepsis in patients with suspicion of NF included female sex, diabetes mellitus, chronic heart disease, hemorrhagic bleb, skin necrosis, and serum protein <6 d/dL. The risk ratio was much higher in patients with total protein less than 6 g/dL, which is associated with malnutrition. Therefore, provision of sufficient nutritional support and close monitoring for these clinical predictors may be beneficial to reduce morbidity and mortality. Dove Medical Press 2015-07-16 /pmc/articles/PMC4509542/ /pubmed/26213473 http://dx.doi.org/10.2147/IDR.S85249 Text en © 2015 Khamnuan et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Khamnuan, Patcharin Chongruksut, Wilaiwan Jearwattanakanok, Kijja Patumanond, Jayanton Tantraworasin, Apichat Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand |
title | Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand |
title_full | Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand |
title_fullStr | Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand |
title_full_unstemmed | Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand |
title_short | Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand |
title_sort | clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern thailand |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509542/ https://www.ncbi.nlm.nih.gov/pubmed/26213473 http://dx.doi.org/10.2147/IDR.S85249 |
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