Prognosis

Prognostic factors in necrotising fasciitis include: (1)

• extent of infection
• delayed first debridement
• multi-organ dysfunction or systemic inflammatory response at presentation
• diabetes mellitus
• peripheral vascular disease
• malnutrition
• malignancy
• immunocompromised states eg HIV/AIDS, steroids, cytotoxics
• obesity
• chronic alcoholism
• IV drug abuse

One study of NF affecting upper or lower limbs found 22.3% underwent amputation or disarticulation of a limb following failure of multiple debridement attempts to control infection. (2)

Mortality from necrotising fasciitis properly treated with surgery plus antibiotics has been estimated at between 10% and 40%. Mortality is higher in patients who develop shock and end-organ damage - approaching 50% to 70% (3)

Reference:

1. Diab J et al. Necrotising fasciitis. BMJ 2020;369:m1428.
2. Angoules AG, Kontakis G, Drakoulakis E, et al; Necrotising fasciitis of upper and lower limb: a systematic review. Injury. 2007 Dec;38 Suppl 5:S19-26
3. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.