Table 7 Summary of published studies of mortality in necrotizing fasciitis/NSTI patients worldwide

Dahm P et al. [40]

2000/USA

Retrospective/1984 to 1998

Overall mortality rate was 20 % (10/50)

The extent of the infection (P = 0.0234) was the only significant, independent predictor of outcome

Chin-Ho Wong et al. [29]

2003/Singapore

Retrospective/1997 to 2002

Total n = 89

A delay in surgery of > 24 h was correlated with increased mortality (p < 0.05; RR = 9.4)

Daniel A. Anaya et al. [32]

2005/USA

Retrospective/1996 to 2001

The overall mortality rate was 16.9 % (total n = 166)

Independent predictors of mortality included WBC > 30 000 × 103/μL, creatinine level > 2 mg/dL (176.8 μmol/L), and heart disease at hospital admission

Kwan MK et al. [41]

2006/Malaysia

Retrospective/1998 to 2002

Overall mortality rate was 36 % (total n = 36)

A poor WBC response, high serum urea and creatinine, and low haemoglobin level were the predictors for mortality

Golger A et al. [18]

2007/Canada

Retrospective/1994 to 2001

Ninety-nine patients satisfied the inclusion criteria. Overall mortality was 20 %

Advanced age (OR, 1.04; 95 % CI, 1.01 to 1.08; p = 0.012), streptococcal toxic shock syndrome (OR, 10.54; 95 % CI, 2.80 to 39.44; p < 0.001), and immunocompromised status (OR, 3.97; 95 % CI, 1.04 to 15.19; p = 0.044) were independent predictors of mortality

Mulla ZD et al. [42]

2007/USA

Case series/2001

The crude hospital mortality rate was 11.1 % (total n = 216)

Patients aged > or =44 years at the time of admission were 5 times as likely to die in the hospital than patients who were aged < or =43 years (adjusted RR 5.08, P = 0.03)

Hsiao CT et al. [9]

2008/Taiwan

Retrospective/2002 to 2005

^a24/128 (19 %)

Aeromonas infection, Vibrio infection, cancer, hypotension, and band form WBC > 10 % were independent positive predictors of mortality (P < 0.05). Presence of hemorrhagic bullae was a negative predictor of mortality (P < 0.05)

Bair MJ et al. [43]

2009/Taiwan

Retrospective/1995 to 2006

The overall mortality was 17.0 %. total n = 85

Predictors of mortality included advanced age, class C liver cirrhosis, ascites, higher serum creatinine, and lower hemoglobin and platelet levels

Kuo Chou TN et al. [44]

2010/Taiwan

Retrospective/2000 to 2007

24/119 (20 %)

The presence of hemorrhagic bullous skin lesions/necrotizing fasciitis, primary septicemia, a greater severity of illness, absence of leukocytosis, and hypoalbuminemia were the significant risk factors for mortality

Kao LS et al. [45]

2011/USA

Retrospective/2004 to 2007

Mortality rates varied between 6 hospitals from 9 % to 25 % (n = 296)

Patient age and severity of disease (reflected by shock requiring vasopressors and renal failure postoperatively) were the main predictors of mortality

Huang KF et al. [8]

2011/Taiwan

Retrospective/2003 to 2009

Overall mortality was 12.1 % (n = 57/472) and the 30 day mortality was 11.0 % (n = 52/472)

Eight independent predictors of mortality : liver cirrhosis, soft tissue air, Aeromonas infection, age > 60 years, band polymorphonuclear neutrophils >10 %, activated partial thromboplastin time >60 s, bacteremia, and serum creatinine >2 mg/dL

Yeung YK et al. [46]

2011/Hong Kong

Retrospective

Overall mortality was 28 % (total n = 29)

Renal and liver failure, thrombocytopenia, initial proximal involvement, and hypotension on admission were predictors of mortality in UL NF. The ALERTS (Abnormal Liver function, Extent of infection, Renal impairment, Thrombocytopenia, and Shock) score with a cutoff of 3 appeared to predict mortality.

Nisbet M et al. [47]

2011/New Zealand

Retrospective/2000 to 2006

Twenty-five (30 %) patients died, 17 (68 %) within 72 h of admission. Total n = 82

Independent predictors of mortality include congestive heart failure (P = 0.033) and a history of gout (P = 0.037)

Krieg et al. [48]

2014/Germany

Retrospective/1996 to 2011

^a24/64(32.8 %)

Independent predictors of mortality were skin necrosis on the initial clinical examination (OR = 15.48; 95 % CI = 2.02–118.91) and acute renal failure (OR = 118.91; 95 % CI 7.66–5135.79)

Lee YC et al. [49]

2014/Taiwan

Retrospective/1996 to 2011

18/100 (18 %)

Unknown injury events, presence of multiple skin lesions, leukocytes < 10,000 cells/mm³, platelets < 100,000/mm³, serum creatinine ≥1.3 mg/dL, serum albumin < 2.5 mg/dL, and delayed treatment beyond 3 days post-injury were associated with significantly higher mortality.

Treatment delayed beyond 3 days is an independent factor indicating a poor prognosis (OR 10.75, 95 % CI 1.02-113.39, p = 0.048)

Khamnuan P et al. [50]

2015/Thailand

Retrospective/2009 to 2012

n = 290/1504 (19.3 %)

Female gender; age >60; chronic heart disease, cirrhosis, skin necrosis, pulse rate >130/min, systolic BP <90 mmHg, and serum creatinine ≥1.6 mg/dL

Khamnuan P et al. [51]

2015/Thailand

Retrospective observational cohort study/2009 to 2012

165 (69.6) in patients with severe sepsis (n = 237)

66 (5.5) without severe sepsis (n = 1,215)

P <0.001

Female sex, diabetes mellitus, chronic heart disease, hemorrhagic bleb, skin necrosis, and serum protein <6 g/dL

Arif et al. [52]

2016/USA

Retrospective/2003 to 2013

9871 NF-related deaths

4 · 8 deaths/

1000000 person-yr

Diabetes mellitus, obesity, and renal failure were significantly associated with NF-related death. However, age, sex, and race were independently associated with the rate of NF-related deaths

Hadeed GJ et al. [35]

2016/USA

Retrospective/2003 to 2008

11/87 (12.5 %)

Clinically significant difference based on the timing of surgical intervention (< or > 6 h) (17.5 % in late vs. 7.5 % in early intervention group), however no statistical significance