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Laboratory Indicators for Early Detection and Surgical Treatment of Vibrio Necrotizing Fasciitis

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

Questions/purposes

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.

Level of Evidence

Level III Prognostic study. See the Guidelines for Authors for complete descriptions of levels of evidence.

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Fig. 1A–D

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Authors and Affiliations

  1. 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

    Yao-Hung Tsai MD, Robert Wen-Wei Hsu MD, Kuo-Chin Huang MD & Tsung-Jen Huang MD

  2. College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China

    Yao-Hung Tsai MD, Robert Wen-Wei Hsu MD, Kuo-Chin Huang MD & Tsung-Jen Huang MD

  3. Department of Orthopedic Surgery, Xiamen Chang Gung Hospital, Xiamen, Fu-Jian, China

    Tsung-Jen Huang MD

Authors
  1. Yao-Hung Tsai MD
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  2. Robert Wen-Wei Hsu MD
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  3. Kuo-Chin Huang MD
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  4. Tsung-Jen Huang MD
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Correspondence to Yao-Hung Tsai MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these case reports that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Chang Gung Memorial Hospital at Chia-Yi.

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Tsai, YH., Hsu, R.WW., Huang, KC. et al. Laboratory Indicators for Early Detection and Surgical Treatment of Vibrio Necrotizing Fasciitis. Clin Orthop Relat Res 468, 2230–2237 (2010). https://doi.org/10.1007/s11999-010-1311-y

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  • DOI: https://doi.org/10.1007/s11999-010-1311-y

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