Background: Necrotizing soft tissue infection (NSTI) of the lower extremity (LE) is a rapidly progressing infection that requires early diagnosis and prompt treatment to decrease risks of loss of limb or life. Clinical presentation, particularly of early NSTI, can appear similar to severe cellulitis. The purpose of this study is to identify factors that are associated with NSTI rather than severe cellulitis to differentiate patients with similar clinical presentation.
Methods: This retrospective cohort design study compares patients finally diagnosed with LE NSTI versus those diagnosed with severe cellulitis. Cohorts were matched using the modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) score in the setting of LE soft tissue infection. Laboratory values, vital signs, subjective symptoms, and social factors including substance abuse were recorded. Univariate and multivariate analyses were performed.
Results: Multivariate statistical analysis and clinical interpretation of data identified four factors more associated with a diagnosis of NSTI than severe cellulitis: elevated lactate, a patient-reported history of fever, male gender, and intravenous substance user.
Conclusion: In patients with lower extremity infections, the clinical presentation of NSTI and severe cellulitis may appear similar. In this retrospective cohort of patients matched with m-LRINEC scores, elevated lactate, subjective fever, male gender, and intravenous substance abuser were significantly associated with NSTI rather than severe cellulitis. Further studies of these factors in the clinical setting can help tailor the differential diagnosis in the care of patients with severe lower extremity infections. Matched with m-LRINEC scores, elevated lactate, subjective fever, male gender, and intravenous substance abuser were significantly associated with NSTI rather than severe cellulitis. Further studies of these factors in the clinical setting can help tailor the differential diagnosis in the care of patients with severe lower extremity infections.



中文翻译：

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通过实验室参数和相关历史记录区分下肢坏死性软组织感染与严重蜂窝织炎

背景：下肢 (LE) 坏死性软组织感染 (NSTI) 是一种进展迅速的感染，需要早期诊断和及时治疗以降低肢体或生命损失的风险。临床表现，尤其是早期 NSTI，可能与严重蜂窝织炎相似。本研究的目的是确定与 NSTI 而不是严重蜂窝织炎相关的因素，以区分具有相似临床表现的患者。
方法：这项回顾性队列设计研究比较了最终诊断为 LE NSTI 的患者与诊断为严重蜂窝织炎的患者。在 LE 软组织感染的情况下，使用改良的坏死性筋膜炎实验室风险指标 (m-LRINEC) 评分对队列进行匹配。记录实验室值、生命体征、主观症状和包括药物滥用在内的社会因素。进行了单变量和多变量分析。
结果：多变量统计分析和数据的临床解释确定了四个与 NSTI 诊断比严重蜂窝织炎更相关的因素：乳酸升高、患者报告的发热史、男性和静脉注射药物使用者。
结论：在下肢感染患者中，NSTI 和严重蜂窝织炎的临床表现可能看起来相似。在这个与 m-LRINEC 评分相匹配的回顾性队列中，乳酸升高、主观发热、男性和静脉药物滥用者与 NSTI 显着相关，而不是严重蜂窝织炎。在临床环境中对这些因素的进一步研究有助于在严重下肢感染患者的护理中定制鉴别诊断。与 m-LRINEC 评分相匹配，乳酸升高、主观发热、男性和静脉药物滥用者与 NSTI 显着相关，而不是严重蜂窝织炎。在临床环境中对这些因素的进一步研究有助于在严重下肢感染患者的护理中定制鉴别诊断。