title: Prognostic factors in necrotizing soft-tissue infections (NSTI): A cohort study.
abstract: BACKGROUND
  Necrotizing soft-tissue infection (NSTI) is uncommon but life-threatening. A recent meta-analysis estimated the overall mortality at 23.5%.
  
  
  OBJECTIVE
  We sought to identify risk factors associated with mortality in a cohort of patients with NSTI in a tertiary care center.
  
  
  METHODS
  We identified 512 patients with NSTI between 1996 and 2012 in the national hospital database Program for Medicalization of Information Systems and examined risk factors of mortality with NSTI by univariate and multivariate analysis.
  
  
  RESULTS
  We included 109 patients with a confirmed diagnosis of NSTI; 31 (28%) died at a median follow-up of 274 days (range 2-6135 days). On multivariate analysis, independent risk factors of mortality were age older than 75 years (hazard ratio [HR] 4.4, 95% confidence interval [CI] 1.8-10.3), multifocal NSTI (HR 5.9, 95% CI 1.9-18.5), severe peripheral vascular disease (HR 5.1, 95% CI 1.5-17.0), hospital-acquired infection (HR 3.9, 95% CI 1.4-10.7), severe sepsis (HR 7.4, 95% CI 1.7-33.1), and septic shock on hospital admission (HR 13.9, 95% CI 3.8-50.4).
  
  
  CONCLUSIONS
  This was a retrospective cohort, which disallows a precise record of the delay between diagnosis and surgery.
  
  
  CONCLUSIONS
  Our findings for this robust cohort of patients with a definite diagnosis of NSTI could help clinicians stratify NSTI severity at clinical course onset.
authors.affiliation: Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Hua
authors.affiliation: Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Pôle Recherche Clinique Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France. Electronic address: emilie.sbidian@hmn.aphp.fr.
authors.forename: Emilie
authors.initials: E
authors.lastname: Sbidian
authors.affiliation: Département d'Information Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Hemery
authors.affiliation: Département de Virologie, Bactériologie- Hygiène, Parasitologie-Mycologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Jean Winoc
authors.initials: JW
authors.lastname: Decousser
authors.affiliation: Service de Chirurgie Plastique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Bosc
authors.affiliation: Service d'Anesthésie et des Réanimations Chirurgicales, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Amathieu
authors.affiliation: Département d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.affiliation: Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Wolkenstein
authors.affiliation: Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Valeyrie-Allanore
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France; UPEC-Université Paris-Est Créteil Val de Marne, Faculté de médecine de Créteil, CARMAS Research Group, Créteil, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France; UPEC-Université Paris-Est Créteil Val de Marne, Faculté de médecine de Créteil, CARMAS Research Group, Créteil, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: de Prost
authors.affiliation: Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chosidow
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis; D062606:Tertiary Care Centers; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: bacterial infection; epidemiology; mortality; necrotizing soft-tissue infection; outcome; prognosis