| 作者 |
Min-Hsiang Hung, Chun-Chia Chen, Shih-Feng Weng, Yu-San Lin, Cheng Liu, Chin-Choon Yeh, Tzong-Bor Sun, Haw-Yen Chiu, Kuo-Feng Huang |
| 摘要 |
Background: Necrotizing fasciitis (NF) is associated with a high mortality rate. Hepatitis is endemic in Taiwan, and liver cirrhosis is associated with the development of NF. The characteristics of these patients, however, have not been well documented or the predictors of mortality clearly identified. The purpose of this study is to identify predictors of mortality in patients with liver cirrhosis and necrotizing fasciitis.
Methods: This study was conducted at the Chi-Mei Medical Center in southern Taiwan. Demographic data, clinical characteristics, and the microorganisms responsible for NF in patients with liver cirrhosis were recorded. To identify independent predictors associated with mortality, univariate analysis followed by multivariate logistic regression modeling was performed.
Results: During the period 2003e2011, a total of 55 patients with liver cirrhosis and NF were treated at the Chi-Mei Medical Center. Most patients had infections by monomicrobial Gramnegative bacilli. Univariate analysis revealed that severity of liver cirrhosis, shock, band polymorphonuclear
neutrophil (>10%), international normalized ratio (>1.5), serum creatinine
(>2.0 mg/dL), serum albumin (<2.5 g/dL), and activated partial thromboplastin time (>60 seconds) were significantly associated with mortality. However, multivariate logistic regression analysis revealed that serum albumin of <2.5 g/dL was the only independent predictor of mortality in patients with liver cirrhosis and NF.
Conclusion: NF in the vast majority of cirrhotic patients was caused by Gram-negative bacilli. Hypoalbuminemia (serum albumin <2.5 g/dL) was associated with mortality in patients with liver cirrhosis and NF. Further studies are needed to assess whether resuscitation with albumin-containing solutions lowers the mortality rate in such patients. |
