Multidisciplinary approach to the treatment of necrotizing soft tissue infection: a case–control study

BACKGROUND: Necrotizing soft tissue infection represents a massive soft tissue lesion accompanied by sepsis. AIM: This work aimed to identify predictors of adverse outcome in patients with necrotizing soft tissue infection treated in the intensive care unit. METHODS: Among 89 patients with sepsis of various etiologies treated in the intensive care unit, 12 patients (6 men and 6 women) with necrotizing soft tissue infection were selected. The patients were divided into two groups according to clinical outcome: group 1 (n = 8) consisted of discharged patients; group 2 (n = 4) included patients with fatal outcome. The obtained data were subjected to statistical analysis. The significance of intergroup differences was assessed using nonparametric statistical methods (Mann–Whitney U test and Pearson’s χ2 test). Differences were considered statistically significant at p = 0.05–0.01. RESULTS: All patients included in the study demonstrated clinical and laboratory signs of sepsis (septic shock). Group 1 demonstrated a significant reduction in inflammatory markers by day 3 of intensive care during intensive therapy including extracorporeal detoxification techniques: C-reactive protein decreased from 296.5 (Me 282.7–361.7) to 66.5 (Me 62.7–105.5) mg/L (p = 0.011), and procalcitonin decreased from 14.66 (Me 1.94–33.20) to 2.81 (Me 0.89–6.03) ng/mL (p = 0.027), along with regression of organ dysfunction. Group 2 showed no positive clinical trends: vasopressor support remained necessary, and levels of inflammatory markers (procalcitonin and C-reactive protein) exceeded baseline values. By day 3 of intensive care, no significant changes in C-reactive protein or procalcitonin levels were detected (p = 0.179). Limb amputations were performed in four patients: in one patient in group 1 and in three patients in group 2. CONCLUSION: Predictors of adverse outcome in necrotizing soft tissue infection include limb amputation due to persistent inflammatory process, sustained requirement for vasopressor support, and absence of positive trends in procalcitonin and C-reactive protein levels.