Prognostic Role of Subsequent Thrombocytopenia in Necrotizing Fasciitis Without Liver Disease

Abstract

Background: Necrotizing fasciitis (NF) is a life-threatening disease with a fulminant presentation. Although early diagnosis can be aided by combining physical examination, the Laboratory Risk Indicator for Necrotizing Fasciitis score, and computed tomography, a mortality rate of 30% is still reported. In the modern times, an economical and efficient biomarker for predicting mortality in NF patients is still lacking. Platelet count is typically measured in routine blood tests and aids in predicting disease severity. We aimed to clarify the role of platelet count as a predictive factor for aspects of prognosis, such as mortality and surgical outcomes, in patients with NF. Methods: We identified 285 patients with NF between 2018 and 2020 in a single medical center in southern Taiwan. Medical records were collected for the evaluation of patients with thrombocytopenia. Univariate and multivariate analyses were performed for different outcomes. Results: We included 115 patients with confirmed diagnoses of NF. Twelve patients died with a mortality rate of 10.4%. Patients with thrombocytopenia exhibited a higher mortality rate (20.9% vs 4.2%, P = 0.006), more shock episodes (51.2% vs 11.1%, P < 0.001), higher intensive care unit admission rate (46.5% vs 13.9%, P < 0.001), and longer hospital length of stay (37.49 ± 24.12 days vs 28.82 ± 14.63 days, P = 0.037) than those without thrombocytopenia. All patients infected with Vibrio species exhibited thrombocytopenia. In multivariate analysis, independent risk factors for mortality were thrombocytopenia (odds ratio, 4.57; 95% confidence interval, 1.08-19.25) and single gram-negative bacterial culture from the wound (odds ratio 6.88; 95% confidence interval, 1.58-29.96). Conclusions: In patients with NF and subsequent thrombocytopenia, a higher mortality rate, greater numbers of shock episodes, higher demand for intensive care unit, and longer hospital length of stay were observed than in those without thrombocytopenia. In patients with NF, platelet count is a valuable and economic indicator of prognosis. Once thrombocytopenia developed in patients with necrotizing fasciitis, aggressive antibiotic treatment and surgical management are required to improve the chances of recovery.

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

“…Therefore, platelet counts have a bimodal relationship with outcomes, in which both abnormally high as well as abnormally low platelet counts are associated with adverse outcomes following infection 3,19,20 . In the present study, we observed that non-survivors had lower platelet counts and greater proportion of patients had thrombocytopenia at admission compared with survivors, aligning with recent findings by Chen et al 21 .…”

Prognostic factors and clinical outcomes in Fournier’s gangrene: A retrospective study of 35 patients

“…The contribution of coagulation dysfunction to the negative impact on mortality in necrotizing soft tissue infections is well established, with declining platelet counts indicating severity in critically ill patients, and coagulopathy correlating with high mortality rates (21,22). Bleeding or disseminated intravascular coagulation events from coagulopathy complicate the treatment of critically ill patients and adversely affect their clinical outcomes (23,24).…”