Factors Associated with Disability and Mortality among Necrotizing Fasciitis Patients in Thailand, 2018

Necrotizing fasciitis (NF) is a serious skin and soft tissue infection that can lead to disabilities and mortalities. A study was carried out to describe demographic characteristics of NF patients, and determine factors associated with disability and mortality. Information on all patients who were diagnosed as NF from 1 Jan to 31 Dec 2018 were extracted from the databases of Health Data Center in Thailand. Univariate and multivariate analyses using logistic regression were performed to determine the associated factors. In 2018, of total 19,071 NF cases, 6.3% died. Median age was 59.7 years old (Q1-Q3 = 49.1-69.5 years). Most of the cases developed NF at ankle and foot (43.0%), followed by lower leg (28.2%). The amputation rate among the cases was 8.2%. Multivariable analysis showed the significant risk factor for amputation as having diabetes mellitus (adjusted OR 6.81, 95% CI 5.97-7.77). Risk factors for mortality included being elderly (OR 1.81, 95% CI 1.56-2.11), and having hypertension (OR 1.17, 95% CI 1.00-1.36), cirrhosis (OR 4.26, 95% CI 3.42-5.28) or cancer (OR 1.88, 95% CI 1.33-2.59). Morbidity and mortality among NF patients were significant in Thailand. Health workers should be trained for early diagnosis and intensive treatment for NF, especially among elderly and patients with chronic diseases in order to prevent the subsequent complications.