| Objective:To explore the clinical features,diagnosis,treatment and prognostic factors of patients with limb necrotizing fasciitis,in order to provide reference for early diagnosis and treatment and prognosis evaluation.Methods:The clinical data of 40 patients with limb necrotizing fasciitis treated in the affiliated Hospital of Jining Medical University from January 2012 to February 2022 were analyzed retrospectively,their clinical characteristics were summarized,According to the prognosis,the patients were divided into death group and survival group.First,univariate analysis was carried out,and the statistically significant indexes were substituted into the binary Logistic regression model for multivariate analysis.The prognostic value of different indexes in patients with limb NF was analyzed by Receiver Operating Characteristic Curve.Then the time from spontaneous illness to admission and from admission to operation were analyzed by Kaplan-Meier Survival Curve,and the survival rates at all time points of death were estimated.Finally,the meaningful indicators of single-factor analysis were substituted into the Cox proportional hazard regression model for multi-factor survival analysis.In order to comprehensively compare the differences of clinical factors between the survival group and the death group,and analyze the relevant factors affecting the prognosis of patients with limb NF.Results:Among 40 patients,13 died and 27 survived,with a mortality rate of 32.5%.The results of single factor analysis show that white blood cell count（19.30±9.91,13.02±6.23）、blood glucose level（14.44±5.28,8.41±5.45）、C-reactive protein（193.99±42.59,129.95±66.94）、serum creatinine（146.57±93.57,68.37±32.98）、procalcitonin（13.83±3.18,9.21±5.46）、D-dimer（2.55±0.90,1.89±0.95）、time from spontaneous illness to admission（8.92±3.43,6.70±3.14）、the number of surgical debridement、the type of comp-lications、whether admitted to ICU、whether VSD drainage、whet-her the emergence of drug-resistant bacteria were significantly different（X~2/t=2.453,3.305,3.664,2.927,2.818,2.098,2.035,4.748,6.686,5.962,5.583,6.857;all P<0.05）.Binary Logistic regression analysis shows that white blood cell（OR=2.032,95%CI1.108-3.726）、blood glucose（OR=1.246,95%CI 1.012-1.537）、C-reactive protein（OR=1.006,95%CI 1.002-1.010）、serum creatinine（OR=1.403,95%CI 1.026-2.198）、procalcitonin（OR=1.223,95%CI 1.018-1.496）、types of complications（OR=1.029,95%CI1.004-1.068）、whether VSD drainage（OR=1.017,95%CI 1.002-1.031）were independent risk factors for poor prognosis in patients with limb NF（P<0.05）.ROC curve analysis showed that the area under the curve（AUC）of white blood cell,blood glucose,C-reactive protein,serum creatinine,procalcitonin,type of complication and whether VSD drainage to predict the prognosis were 0.711（95%CI 0.535-0.886,P<0.05）、0.832（95%CI 0.707-0.957,P<0.01）、0.782（95%CI 0.640-0.924,P<0.01）、0.766（95%CI 0.593-0.939,P<0.01）、0.838（95%CI 0.711-0.964,P<0.01）、0.718（95%CI0.547-0.889,P<0.05）、0.699（95%CI 0.526-0.873,P<0.05）respectively.K-M survival curve showed that the cumulative survival rate decreased gradually with the prolongation of the time from onset to admission and from admission to operation.COX regression analysis showed that white blood cells（HR=1.235,95%CI 1.012-1.507）、C-reactive protein（HR=1.025,95%CI 1.002-1.049）、procalcitonin（HR=0.557,95%CI 0.320-0.971）、number of operations（HR=13.275,95%CI 1.071-164.581）、time from onset to admission（HR=2.739,95%CI 1.436-5.224）were risk factors for poor prognosis in patients with limb NF.Conclusion:White blood cells,blood glucose,C-reactive protein,serum creatinine,procalcitonin,types of complications and VSD drainage can be used as related indexes to evaluate the prognosis of patients with limb NF,while white blood cells,C-reactive protein,procalcitonin,times of operation and the time from onset to admission are the main risk factors affecting the survival time of patients with NF. |
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