A ten-year update on necrotising fasciitis at a single tertiary centre: Factors influencing survival outcomes.

Abstract

We aimed to evaluate clinical outcomes and predictive factors associated with necrotising fasciitis (NF) in patients referred to a tertiary centre over a 10-year period. Objectives included analysis of mortality rates, prognostic utility of the laboratory risk indicator for necrotising fasciitis (LRINEC) score and factors influencing management and outcomes for patients presenting with NF. All patients with a confirmed diagnosis of NF from January 2015 to March 2025 were identified through a retrospective database. Demographic, clinical and laboratory data were analysed. Mortality predictors were assessed using univariate and multivariate logistic regression. Associations with LRINEC scores and the presence of Group A streptococcus were evaluated. A total of 87 patients were included with a mean age of 56.5 years; 60.9% were men. Overall mortality was 36.8% with 23.0% within 30 days. The median time to theatre was 8.8 h and intensive care unit (ICU) admission was required in 58.6% of cases. In the univariate analysis, mortality increased with age (OR 1.059, p<0.001), ischaemic heart disease and chronic kidney disease. Multivariate analysis confirmed age (OR 1.104, p<0.001), requirement for renal replacement therapy and/or ventilatory support (OR 23.6, p=0.008), immunosuppression (OR 6.03, p=0.038) and white cell count (OR 0.860, p=0.008) as independent predictors of mortality. LRINEC score >6 was not independently predictive of mortality. NF is associated with high early mortality and ICU burden. Age, immunosuppression and organ support are key mortality predictors. Early recognition and wide margin excision of tissue with ICU support remain critical for patient survival.