Prediction of mortality in necrotizing fasciitis: comparative evaluation of established prognostic scores and a novel scoring system in a retrospective cohort

BACKGROUND: Necrotizing fasciitis (NF) is a rare but serious surgical emergency that progresses rapidly, requires urgent operative intervention, and carries a high mortality rate. Current prognostic scoring systems may have limited predictive power for mortality across different patient groups. The aim of this study was to identify clinical, laboratory, and radiological factors associated with mortality in patients with necrotizing fasciitis. In addition, the study aimed to provide a foundation for the development of a practical prognostic scoring system that could support early risk stratification in clinical practice. METHODS: This retrospective cohort study examined data from 65 patients diagnosed with NF between January 2021 and December 2024. A modified scoring system was created by integrating the Charlson Comorbidity Index and the total body surface area ratio (Samsun Charlson Comorbidity Index, SaCCI). Sarcopenia was assessed using the psoas muscle index. Using receiver operating characteristic (ROC) analysis, the mortality predictive performance of the modified scoring system was calculated and compared with existing systems. RESULTS: The SaCCI score demonstrated higher prognostic accuracy than existing systems in predicting mortality, achieving the highest discriminatory power with an area under the curve (AUC) of 0.885. Higher SaCCI scores were associated with a significantly increased risk of mortality. Sarcopenia and delayed surgical intervention were also associated with mortality. CONCLUSION: The SaCCI score shows promise as an effective tool for predicting early mortality risk in patients with necrotizing fasciitis. The validity of this scoring system, which may inform clinical decision-making, should be confirmed by further multicenter studies.