Laboratory indicators for early detection and surgical treatment of vibrio necrotizing fasciitis.
BACKGROUND
Vibrio necrotizing fasciitis is a rare and life-threatening soft tissue infection, with fulminant clinical courses and high mortality rates. However, the lack of specific disease characteristics and diagnostic tools during the initial examination may delay diagnosis.


OBJECTIVE
We (1) asked whether the clinical indicators could predict laboratory findings during the initial stage of Vibrio necrotizing fasciitis and (2) determined the relationships between the laboratory risk indicator for necrotizing fasciitis (LRINEC) score and the diagnosis of Vibrio infection.


METHODS
We retrospectively reviewed 70 patients with 71 episodes of Vibrio necrotizing fasciitis and sepsis. Of the 70 patients, 68 had a history of contact with seawater or raw seafood; 66 had underlying chronic diseases.


RESULTS
Eighteen patients (25.7%) died a mean 18.7 days after admission, and 52 patients survived. A systolic blood pressure of 90 mm Hg or less at the time of admission to the emergency room was associated with mortality. Patients who died had lower leukocyte counts, segmented leukocyte counts, platelet counts, and serum albumin levels compared with the patients who survived and higher counts of band forms of leukocytes. Only eight patients (11%) who survived had a LRINEC score of 6 or greater.


CONCLUSIONS
The LRINEC scoring system is not applicable when treating such a highly lethal disease. We propose that severe hypoalbuminemia, severe thrombocytopenia, and increased banded forms of leukocytes are laboratory risk indicators of necrotizing fasciitis that aid in pointing toward initiation of early surgery and predict a higher risk of death.


METHODS
Level III Prognostic study. See the Guidelines for Authors for complete descriptions of levels of evidence.
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, 6 West Sec, Chia-Pu Rd, Putz City, Chia-Yi, 613 Taiwan, Republic of China. orma2244@adm.cgmh.org.tw
Yao-Hung
YH
Tsai
Robert Wen-Wei
RW
Hsu
Kuo-Chin
KC
Huang
Tsung-Jen
TJ
Huang
D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007962:Leukocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014735:Vibrio Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D041261:Vibrio vulnificus / Q000302:isolation & purification*
D015415:Biomarkers; D012709:Serum Albumin