1
|
Perez RD, Villena MA, Zavaleta-Corvera C, Caballero-Alvarado J, Zafra C, Pozzuoli G. [Neutrophil-to-lymphocyte ratio as a predictor of intestinal resection in incarcerated inguinal hernias]. Khirurgiia (Mosk) 2024:51-57. [PMID: 38888019 DOI: 10.17116/hirurgia202401151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Inguinal hernia is defined as a projection of an organ through the inguinal canal. This can be incarcerated as a consequence of continuous inflammation of the hernial sac, which will prevent its return, causing damage to the venous and lymphatic return of the viscera. The neutrophil-to-lymphocyte ratio (NLR) is an easily accessible inflammatory biomarker obtained from blood cell counts. Therefore, the objective was to determine if the NLR is useful as a predictor of intestinal resection in incarcerated inguinal hernias. MATERIAL AND METHOD An observational, analytical, diagnostic test and retrospective study was carried out in a hospital in northern Peru from January 2013 to August 2019 in the Department of General Surgery and Emergency Surgery and Critical Care. Patients diagnosed with unilateral inguinal hernia with intestinal obstruction were included. For the relationship between the event and the exposure, it was analyzed using Chi square (χ2) and T-Student. The sensitivity, specificity, positive predictive value, negative predictive value of the NLR as well as the area under the ROC curve were found to determine the predictive accuracy. RESULTS 161 patients with incarcerated inguinal hernia were studied: group I (20 patients with intestinal resection) and group II (141 patients without intestinal resection). The mean age in groups I and II were 69±16 and 60±17 years (p<0.05); the frequency in males was 70% in group I and 76% in group II (p>0.05). Intestinal obstruction and duration of incarceration >24 hours and the platelet-to-lymphocyte ratio demonstrated significant differences. With respect to NLR taking a cut-off point ≥6.5, a sensitivity of 75%, a specificity of 93.62%, a positive predictive value of 62.5% and a negative predictive value of 96.35% were observed; In addition, when analyzing with the ROC curve, a value of 5.14 was obtained as a predictor of intestinal resection with a sensitivity of 90% and a specificity of 84.4% (p<0.001). Therefore, the NLR >5.14 predicts intestinal resection in patients with incarcerated inguinal hernias with an area under the curve of 0.92 at the Belen Hospital of Trujillo. CONCLUSIONS The neutrophil-to-lymphocyte ratio is useful for predicting intestinal resection with a diagnostic accuracy of 92%.
Collapse
Affiliation(s)
- R D Perez
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - M A Villena
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
- Belen Hospital of Trujillo, Trujillo, Peru
| | | | - J Caballero-Alvarado
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
- Regional Hospital of Trujillo, Trujillo, Peru
| | - Ch Zafra
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - G Pozzuoli
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| |
Collapse
|
2
|
Wu H, Li C, Liu S, Yao S, Song Z, Ren D, Wang P. Is Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio or Red Blood Cell Distribution Width Associated with Risk of Mortality in Patients with Necrotizing Fasciitis. Infect Drug Resist 2023; 16:3861-3870. [PMID: 37346369 PMCID: PMC10281279 DOI: 10.2147/idr.s413126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and red blood cell distribution width (RDW) are novel biomarkers to indicate the inflammatory/immune response, and demonstrated to be effective in diagnosis, severity evaluation, and prognosis in a variety of chronic or acute conditions. This study aims to examine whether NLR, PLR and EDW are independently associated with mortality in necrotizing fasciitis (NF). Methods This study retrospectively enrolled patients diagnosed with NF and based on vitality status during hospitalization or within 30 days after discharge, survival and non-survival groups were defined. For distinctly comparing NLR, PLR, RDW and others, we enrolled the matched healthy controls of the same age and sex as the survivors of NF in a 1:1 ratio, which constituted the healthy control group. Comparisons were made between three groups. Variables tested with a P value < 0.10 were further entered into the multivariate logistic regression model to identify their independent association with mortality. Results A total of 281 subjects were included, including 127 healthy controls, 127 survivors, and 27 nonsurvivors with NF, respectively, indicating a mortality rate of 17.5%. ROC analysis showed that the optimal cutoff value for NLR, PLR and RDW was 11.1, 196.0 and 15.5%, respectively, and was tested as significant only for the first two (P < 0.001, = 0.004). Multivariate logistic analysis showed that NLR ≥ 11.1 (OR, 2.51) and PLR ≥ 196.0 (OR, 2.09) were independently associated with an increased risk of mortality in NF patients, together with age ((OR, 1.28, for each 10-year increment), comorbid diabetes mellitus (OR, 2.69) and liver disease (OR, 1.86), and elevated creatinine level (OR, 1.21 for each 10 umol/L elevation). Conclusion Elevated NLR and PLR are significant and independent predictors of mortality and can be considered for use when evaluating patients at risk of mortality.
Collapse
Affiliation(s)
- Haotian Wu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Chunxia Li
- Department of Imaging Medicine, General Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia, 010017, People’s Republic of China
| | - Song Liu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Shuangquan Yao
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Zhaohui Song
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Dong Ren
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Pengcheng Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| |
Collapse
|
3
|
Brown M, Nassoiy S, Plackett T, Luchette F, Posluszny J. Red blood cell distribution width and outcome in trauma patients. J Osteopath Med 2021; 121:221-228. [PMID: 33567079 PMCID: PMC8086633 DOI: 10.1515/jom-2020-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Context Red blood cell distribution width (RDW) has been used to predict mortality during infection and inflammatory diseases. It also been purported to be predictive of mortality following traumatic injury. Objective To identify the role of RDW in predicting mortality in trauma patients. We also sought to identify the role of RDW in predicting the development of sepsis in trauma patients. Methods A retrospective observational study was performed of the medical records for all adult trauma patients admitted to Loyola University Medical Center from 2007 to 2014. Patients admitted for fewer than four days were excluded. Admission, peak, and change from admission to peak (Δ) RDW were recorded to determine the relationship with in-hospital mortality. Patient age, development of sepsis during the hospitalization, admission to the intensive care unit (ICU), and discharge disposition were also examined. Results A total of 9,845 patients were admitted to the trauma service between 2007 and 2014, and a total of 2,512 (25.5%) patients fit the inclusion criteria and had both admission and peak values available. One-hundred twenty (4.6%) died while in the hospital. RDW values for all patients were (mean [standard deviation, SD]): admission 14.09 (1.88), peak 15.09 (2.34), and Δ RDW 1.00 (1.44). Admission, peak, and Δ RDW were not significant predictors of mortality (all p>0.50; hazard ratio [HR], 1.01-1.03). However, trauma patients who eventually developed sepsis had significantly higher RDW values (admission RDW: 14.27 (2.02) sepsis vs. 13.98 (1.73) no sepsis, p<0.001; peak RDW: 15.95 (2.55) vs. 14.51 (1.97), p<0.001; Δ RDW: 1.68 (1.77) vs. 0.53 (0.91), p<0.001). Conclusion Admission, peak, and Δ RDW were not associated with in-hospital mortality in adult trauma patients with a length of stay (LOS) ≥four days. However, the development of sepsis in trauma patients is closely linked to increased RDW values and in-hospital mortality.
Collapse
Affiliation(s)
- McKenzie Brown
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
| | - Sean Nassoiy
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
| | - Timothy Plackett
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA.,759th Forward Surgical Team , BLDG A-6631 Gorham Street , 28310-0001 Fort Bragg , NC , USA
| | - Fred Luchette
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA.,Department of Surgery , Edward Hines Jr. Veterans Administration Hospital , Hines , IL , USA
| | - Joseph Posluszny
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
| |
Collapse
|
4
|
A novel nomogram predicting the risk of positive biopsy for patients in the diagnostic gray area of prostate cancer. Sci Rep 2020; 10:17675. [PMID: 33077762 PMCID: PMC7572499 DOI: 10.1038/s41598-020-74703-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
The roles played by several inflammatory factors in screening for prostate cancer (PCa) among gray area patients, namely those with serum prostate-specific antigen (PSA) levels between 4 and 10 ng/ml, have not been completely identified, and few effective diagnostic nomograms have been developed exclusively for these patients. We aimed to investigate new independent predictors of positive biopsy (PB) results and develop a novel diagnostic nomogram for this group of patients. The independent predictors of PB results were identified, and a nomogram was constructed using multivariate logistic regression analysis based on a cohort comprising 401 Gy area patients diagnosed at Xijing Hospital (Xi’an, China) between January 2016 and December 2019. The predictive accuracy of the nomogram was assessed using the receiver operating characteristic curve, and the nomogram was calibrated by comparing the prediction with the observation. The performance of the nomogram was further validated using an independent cohort. Finally, lymphocyte-to-monocyte ratio (LMR) > 4.11 and red blood cell distribution width (RDW)-standard deviation (SD) > 42.9 fl were identified as independent protective predictors of PB results, whereas PSA density (PSAD) > 0.141 was identified as an independent risk predictor. The nomogram established using PSAD, LMR, and RDW-SD was perfectly calibrated, and its predictive accuracy was superior to that of PSAD in both internal and external validations (0.827 vs 0.769 and 0.765 vs 0.713, respectively). This study is the first to report the importance of LMR and RDW-SD in screening for PCa among gray area patients and to construct an exclusive nomogram to predict the individual risk of positive 13-core biopsy results in this group of patients. With superior performance over PSAD, our nomogram will help increase the accuracy of PCa screening, thereby avoiding unnecessary biopsy.
Collapse
|
5
|
The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections. Eur J Trauma Emerg Surg 2018; 45:919-926. [PMID: 29789865 DOI: 10.1007/s00068-018-0958-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/18/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Severe necrotizing soft-tissue infections (NSTIs) require immediate early surgical treatment to avoid adverse outcomes. This study aims to determine the impact of early surgery and comorbid conditions on the outcomes of NSTIs. METHODS A retrospective cohort study was performed on all subjects presenting with NSTI at an academic medical center between 2005 and 2016. Patients were identified based on ICD codes. Those under the age of 18 or with intraoperative findings not consistent with NSTI diagnosis were excluded. RESULTS There were 115 patients with a confirmed diagnosis of NSTI with a mean age of 55 ± 18 years; 41% were females and 55% were diabetics. Thirty percent of patients underwent early surgery (< 6 h). There were no significant differences between groups in baseline characteristics. The late group (≥ 6 h) had prolonged hospital stay (38 vs. 23 days, p < 0.008) in comparison to the early group (< 6 h). With every 1 h delay in time to surgery, there is a 0.268 day increase in length of stay, adjusted for these other variables: alcohol abuse, number of debridements, peripheral vascular disease, previous infection and clinical necrosis. Mortality was 16.5%. Multivariable analysis revealed that alcohol abuse, peripheral vascular disease, diabetes, obesity, hypothyroidism, and presence of COPD were associated with an increase in mortality. CONCLUSIONS Early surgical intervention in patients with severe necrotizing soft-tissue infections reduces length of hospital stay. Presence of comorbid conditions such as alcohol abuse, peripheral vascular disease, diabetes, obesity and hypothyroidism were associated with increased mortality.
Collapse
|
6
|
Safdar SA, Modi T, Sriramulu LD, Shaaban H, Sison R, Modi V, Adelman M, Guron G. The Role of Red Cell Distribution Width as a Predictor of Mortality for Critically Ill Patients in an Inner-city Hospital. J Nat Sci Biol Med 2017; 8:154-158. [PMID: 28781479 PMCID: PMC5523520 DOI: 10.4103/0976-9668.210017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Red cell distribution width (RDW) is a measure of the variation in the red blood cell volume that is usually recorded as a part of the standard complete blood cell count. Recent studies have demonstrated the prognostic value of RDW in many different clinical settings. The objective of this research study is to investigate the independent association of RDW with 30-day mortality in Intensive Care Unit (ICU) patients. Methods: One hundred and fifty-six patients admitted to the ICU of our hospital between July 2009 and June 2011 were included in our study. Out of 156 patients, 124 survived the hospital stay. The data on patient's demographics, interventions done in ICU, and their comorbidities were collected. Baseline variables and the RDW value were compared between survivors and nonsurvivors. The cutoff point for RDW used for the comparison was 15.75. Both univariable and multivariable analyses were done. P < 0.05 was considered statistically significant. Results: In the univariable analysis of the study between survivors and nonsurvivors, the median RDW was 17.20 for nonsurvivors, implying statistical significance (P = 0.007). In multivariable analysis, RDW remained significantly associated with inpatient mortality. The receiver operating characteristic is 0.656 (P = 0.007), with an optimal cutoff of 15.75 for RDW. At the cutoff of RDW, i.e., 15.75, the sensitivity and specificity for inpatient mortality was 71% and 89%, respectively. Conclusion: In critically ill ICU patients, RDW is an independent predictor of 30-day mortality. Taking into consideration the fact that RDW is routinely measured in complete blood count with no additional cost, this can serve as an “inexpensive prognostic marker” in critically ill patients.
Collapse
Affiliation(s)
- Syed Atif Safdar
- Department of Pulmonary Medicine and Critical Care Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA
| | - Tejas Modi
- Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Hematology and Oncology, St. Michael's Medical Center, Newark, NJ, USA
| | - Lakshmi Durga Sriramulu
- Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Infectious Disease, St. Michael's Medical Center, Newark, NJ, USA
| | - Hamid Shaaban
- Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Hematology and Oncology, St. Michael's Medical Center, Newark, NJ, USA
| | - Raymund Sison
- Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Infectious Disease, St. Michael's Medical Center, Newark, NJ, USA
| | - Varun Modi
- Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Hematology and Oncology, St. Michael's Medical Center, Newark, NJ, USA
| | - Marc Adelman
- Department of Pulmonary Medicine and Critical Care Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA
| | - Gunwant Guron
- Department of Internal Medicine, St. Michael's Medical Center, Newark, NJ, USA.,Department of Hematology and Oncology, St. Michael's Medical Center, Newark, NJ, USA
| |
Collapse
|
7
|
Demiray O, Cevik E, Cuce F. Association Between Complete Blood Count Parameters and Urinary Stone Disease. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24319. [PMID: 27651947 PMCID: PMC5020604 DOI: 10.5812/ircmj.24319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/02/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Complete blood count (CBC) parameters may associated with multiple diseases. Urinary stone disease is common public problem. Predictive value of CBC parameters may be associated with urinary stone disease. OBJECTIVES To analyze the association between complete blood count (CBC) parameters and urinary stone disease. PATIENTS AND METHODS This study was a retrospective observational study of 3,099 patients who were admitted to the urology outpatient clinic or diagnosed with urinary stone disease in the emergency services department. There were 353 patients included in the study that had ultrasonography (USG) and/or non-contrast computerized tomography (NCCT) and a CBC. Patients who had non-urinary system inflammatory disease in USG or NCCT, had fever, non-urinary system infection, anemia or diagnosed hematologic malignancy were excluded (n = 27). Patients were divided into two groups: a stone group (n = 74) and a control group (n = 252). Data of patients were retrieved from the hospital database and statistical analysis was performed. RESULTS An increase in RDW, MPV, PDW, WBC, granulocyte percentage and a decrease in lymphocyte percentage is statistically associated with urinary stone disease (P < 0,001, P < 0.001, P = 0.006, P < 0.001, P = 0.003, P = 0.034, respectively). Microscopic hematuria is associated with urinary stone disease and the odds ratio for urinary stone prediction is 67.7 (P < 0.001). In addition, none of the CBC parameters were associated with stone burden. CONCLUSIONS When evaluating flank pain in patients, it is important to remember that CBC parameters may support urinary stone disease, and considering CBC results may be useful in the diagnosis of urinary stone disease.
Collapse
Affiliation(s)
- Ozay Demiray
- Department of Urology, Van Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey
| | - Erdem Cevik
- Department of Emergency Medicine, Van, Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey
- Corresponding Author: Erdem Cevik, Department of Emergency Medicine, Van Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey. Tel: +90-4322223329, E-mail:
| | - Ferhat Cuce
- Department of Radiology, Van Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey
| |
Collapse
|
8
|
Podhorecka M, Halicka D, Szymczyk A, Macheta A, Chocholska S, Hus M, Darzynkiewicz Z. Assessment of red blood cell distribution width as a prognostic marker in chronic lymphocytic leukemia. Oncotarget 2016; 7:32846-53. [PMID: 27147570 PMCID: PMC5078056 DOI: 10.18632/oncotarget.9055] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/08/2016] [Indexed: 01/25/2023] Open
Abstract
Red blood cell distribution width (RDW) is a quantitative measure of the variability in size of circulating erythrocytes. It was recently reported that RDW is a prognostic factor for infection diseases, cardiovascular and pulmonary diseases, as well as some neoplasms. Moreover, RDW is remarkably strong predictor of longevity, including all causes of death, for adults aged 45 years and older. To explain this occurrence it was proposed that persistent IGFs/mTOR signaling is one of the factors that play a role in affecting the RDW and mortality.The above observations induced us to analyze the prognostic role of RDW in chronic lymphocytic leukemia (CLL) being the most frequent type of adult leukemia in Western countries. The obtained results have shown that RDW may be considered as a potential CLL prognostic marker. Elevated RDW level at the moment of diagnosis was associated with advanced disease and presence of other poor prognostic factors. It is also connected with overall survival indicating shorter time in patients with elevated RDW. It is possible that the presently observed correlation between mortality and RDW of the CLL patients is affected by their metabolic (IGF-1/mTOR driven)- rather than chronological- aging. The patients with high level of RDW are expected to have an increased persistent level of IGF-1/mTOR signaling. Within the framework of personalized therapy, these CLL patients therefore would be expected to be more sensitive to the treatment with mTOR inhibitors.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Erythrocyte Indices
- Erythrocytes/metabolism
- Female
- Humans
- Insulin-Like Growth Factor I/metabolism
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Molecular Targeted Therapy
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Protein Kinase Inhibitors/therapeutic use
- Retrospective Studies
- Risk Factors
- Signal Transduction
- TOR Serine-Threonine Kinases/antagonists & inhibitors
- TOR Serine-Threonine Kinases/blood
Collapse
Affiliation(s)
- Monika Podhorecka
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Dorota Halicka
- Department of Pathology, New York Medical College, Valhalla, New York, USA
| | - Agnieszka Szymczyk
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Arkadiusz Macheta
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Sylwia Chocholska
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | | |
Collapse
|
9
|
Borschitz T, Schlicht S, Siegel E, Hanke E, von Stebut E. Improvement of a Clinical Score for Necrotizing Fasciitis: 'Pain Out of Proportion' and High CRP Levels Aid the Diagnosis. PLoS One 2015. [PMID: 26196941 PMCID: PMC4511009 DOI: 10.1371/journal.pone.0132775] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Necrotizing fasciitis (NF) is a rare mono-/polymicrobial skin infection that spreads to underlying tissues. NF is quickly progressing and leads to life threatening situations. Immediate surgical debridement together with i.v. antibiotic administration is required to avoid fatal outcome. Early diagnosis is often delayed due to underestimation or confusion with cellulitis. We now compared the initial clinical and laboratory presentation of NF and cellulitis in detail to assess if a typical pattern can be identified that aids timely diagnosis of NF and avoidance of fatal outcome. 138 different clinical and laboratory features of 29 NF patients were compared to those of 59 age- and gender matched patients with severe erysipelas requiring a subsequent hospitalization time of ≥10 days. Differences in clinical presentation were not obvious; however, NF patients suffered significantly more often from strong pain. NF patients exhibited dramatically elevated CRP levels (5-fold, p>0.001). The overall laboratory risk indicator for necrotizing fasciitis (LRINEC) score was significantly higher in NF patients as compared to cellulitis. However, a modification of the score (alteration of laboratory parameters, addition of clinical parameters) led to a clear improvement of the score with a higher positive predictive value without losing specificity. In summary, clinical differentiation of NF from cellulitis appears to be hard. ‘Pain out of proportion’ may be an early sign for NF. An improvement of the LRINEC score emphasizing only relevant laboratory and clinical findings as suggested may aid the early diagnosis of NF in the future leading to improvement of disease outcome by enabling rapid adequate therapy.
Collapse
Affiliation(s)
| | - Svenja Schlicht
- Department of Dermatology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ekkehard Siegel
- Institute for Medical Microbiology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric Hanke
- Department of Traumatology/Orthopedics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Esther von Stebut
- Department of Dermatology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- * E-mail:
| |
Collapse
|
10
|
Sertoglu E, Uyanik M, Kayadibi H. Is red blood cell distribution width enough to predict prognosis of necrotizing fasciitis? Am J Emerg Med 2015; 33:301-2. [PMID: 25488340 DOI: 10.1016/j.ajem.2014.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/18/2014] [Indexed: 02/07/2023] Open
Affiliation(s)
- Erdim Sertoglu
- Ankara Mevki Military Hospital, Anittepe Dispensary, Biochemistry Laboratory, Ankara, Turkey.
| | - Metin Uyanik
- Corlu Military Hospital, Biochemistry Laboratory, Tekirdag, Turkey
| | | |
Collapse
|
11
|
Jiang L, Zhang M, Ma Y. Can red cell distribution width predict mortality rate in patients with necrotizing fasciitis? Am J Emerg Med 2014; 32:1537-8. [PMID: 25453472 DOI: 10.1016/j.ajem.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Libing Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine&Institute of Emergency Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, China.
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine&Institute of Emergency Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, China.
| | - Yuefeng Ma
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine&Institute of Emergency Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, China.
| |
Collapse
|