Escalas de gravedad en la unidad de cuidados intensivos y sistemas de puntuación específicos de la enfermedad como predictores de mortalidad en adultos con infecciones necrosantes de tejidos blandos. Revisión sistemática y metaanálisis

Abstract

Introduction

Necrotizing soft tissue infections are uncommon dermatologic and surgical emergencies, but they are associated with high mortality. In critically ill patients, uncertainty remains regarding which early prognostic scores best predict mortality.

Methods

A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. The protocol was registered in PROSPERO (CRD420251272457). Studies including adults with necrotizing soft tissue infections admitted to the intensive care unit that evaluated clinical scores measured at admission or within the first 24 h were included. The search was performed in PubMed/MEDLINE, Web of Science, and Scopus. Risk of bias was assessed using ROBINS-E, and certainty of the evidence was evaluated with GRADE.

Results

Twelve observational studies were included, and mortality ranged from 13.8% to 43.8%. Older age (MD 13.95 years; 95% CI: 10.80–17.10), APACHE II (MD 7.74 points; 95% CI: 5.57–9.91), SAPS II (effect per point 0.04; 95% CI: 0.03–0.06), and shock/hypotension (OR 4.15; 95% CI: 2.41–7.14) were associated with higher mortality, whereas LRINEC did not show a statistically significant association (MD 1.14 points; 95% CI: − 0.12 to 2.41).

Conclusions

In adults with necrotizing soft tissue infections admitted to intensive care, mortality is primarily associated with organ dysfunction and early hemodynamic instability rather than with scores based mainly on laboratory parameters, such as LRINEC. In this context, APACHE II and SAPS II appear to be the most useful tools for initial risk stratification, whereas older age and shock constitute markers of greater severity.