Hong Kong Med J 2011;17:96–104 | Number 2, April 2011
Factors affecting mortality in Hong Kong patients with upper limb necrotising fasciitis
Yeung YK, Ho ST, Yen CH, Ho PC, Tse WL, Lau YK, Choi KY, Choi ST, Lam MM, Cheng SH, Wong TC; The Hong Kong Society for Surgery of the Hand
Department of Orthopaedics, Caritas Medical Centre, Shamshuipo, Kowloon, Hong Kong
OBJECTIVE. To identify predictive factors for mortality of patients with upper limb necrotising fasciitis.
DESIGN. Retrospective study.
SETTING. Six hospitals in Hong Kong.
PATIENTS. Clinical records of 29 patients treated in the hospitals were traced and analysed.
MAIN OUTCOME MEASURES. Possible predictive factors for mortality as evaluated by application of Fisher's test.
RESULTS. Overall mortality was 28%. Digital infections conferred a lower mortality, but progressive necrosis necessitated amputation. Vibrio vulnificus was the commonest organism identified in association with marine injury and in patients with cirrhosis. Prognostic indicators with decreasing significance include deranged renal and liver function, thrombocytopaenia, proximal involvement (elbow or above) initially, and presence of hypotension upon admission.
CONCLUSION. With a P value of less than 0.05, deranged renal and liver function, thrombocytopaenia, initial proximal involvement, and hypotension on admission were predictors of mortality in necrotising fasciitis affecting the upper limbs. The ALERTS (Abnormal Liver function, Extent of infection, Renal impairment, Thrombocytopenia, and Shock) score with a cutoff of 3 appeared to predict mortality.
Key words: Bacterial infections; Debridement; Fasciitis, necrotizing; Upper extremity; Vibrio vulnificus
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