ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Risk factors and predictors of in-hospital mortality in necrotizing fasciitis: a five-year retrospective cohort study from a tertiary care center in Colombia.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeNecrotizing fasciitis (NF) is a life-threatening soft tissue infection with limited epidemiological data from Latin America. This study aimed to characterize clinical outcomes, identify factors associated with in-hospital mortality, and develop a clinical prediction model in patients with NF at a tertiary care center in Medellín, Colombia.
methodsA retrospective cohort study was conducted including all adult patients (≥ 18 years) with surgically or histopathologically confirmed NF between January 2019 and December 2024. Demographic, clinical, microbiological, and therapeutic variables were collected. Bivariable analysis and multivariable logistic regression were performed to identify independent mortality predictors. A clinical risk score was developed and internally validated using bootstrap resampling and 10-fold cross-validation.
resultsOf 112 identified patients, 111 met inclusion criteria. Overall in-hospital mortality was 23.4% (26/111). Deceased patients were significantly older (median 69.5 vs. 52 years; p < 0.001). Serum lactate demonstrated strong prognostic value (AUC 0.719; 95% CI 0.596-0.842; 2.9 vs. 1.8 mmol/L; p = 0.003). Septic shock was present in 34.2% and doubled mortality risk (34.2% vs. 17.8%; p = 0.060). Polymicrobial infections predominated (74.8%), with a predominantly gram-negative profile and high antimicrobial resistance rates (carbapenemase-producing organisms 19.8%, ESBL 12.6%). Culture-negative infections were strongly associated with mortality (60.0%; OR 6.07, 95% CI 1.56-23.6; p = 0.009). The LRINEC score, designed as a diagnostic tool, did not discriminate mortality (AUROC 0.463), consistent with its diagnostic rather than prognostic design. In multivariable analysis, age (OR 1.07 per year; 95% CI 1.04-1.11; p < 0.001) and immunosuppression (OR 4.06; 95% CI 0.84-19.51; p = 0.073) were retained as predictors. The proposed two-variable exploratory model (age + immunosuppression) demonstrated an AUROC of 0.798 (95% CI 0.713-0.884), with minimal incremental value over an age-only model (AUROC 0.776; ΔAUROC 0.022).
conclusionNF remains highly lethal, with age as the strongest independent prognostic factor and immunosuppression as an exploratory signal; serum lactate and septic shock are key markers of severity.The proposed exploratory score is largely driven by age and offers only modest incremental discrimination over age alone; external multicenter validation is required before any clinical implementation.
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