Prognostic Factors Associated With Mortality Among Patients With Necrotizing Soft-Tissue Infection: A Systematic Review and Meta-Analysis.

Abstract

Necrotizing soft-tissue infections (NSTIs) are rapidly progressive infections often characterized by widespread necrosis, sepsis, and multiple organ failure. As such, it is important to individualize treatment decisions using evidence-based prognostication. We aimed to summarize the prognostic association between patient and disease factors and mortality among adult patients with NSTI. We searched three databases (Medline, Embase, and the Cochrane Central Register of Controlled Trials) from inception to September 29, 2025. We included studies that enrolled adult patients with NSTI and evaluated prognostic factors associated with short-term mortality using adjusted models that account for at least age and comorbidity. We pooled effect estimates using a random-effects model. We assessed risk-of-bias using the Quality in Prognosis Studies tool and assessed certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluations methodology. We included 41 observational cohort studies involving 168,261 patients. Studies were predominantly retrospective cohorts. Patient factors with a moderate or high certainty of association with increased mortality include older age, chronic liver disease, chronic kidney disease, high Charlson Comorbidity Index, and immunosuppression. Disease factors with a moderate or high certainty of association with increased mortality include hypotension, bacteremia, acute kidney injury, coagulopathy, thrombocytopenia, and shock. Several patient and illness factors demonstrate important association with mortality among patients with NSTI. Clinicians should consider these factors in decisions related to escalation of therapy, and counseling patients and family members on potential outcomes.