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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of liver cirrhosis on morbidity and mortality of patients admitted to the hospital with necrotizing fasciitis
Mohamad El Labban, Juliet Kotys, Sabrina Makher, Sai Shanmukha Sreeram Pannala, Khalil El Gharib, Hamed Chehab, Liliane Deeb, Salim R Surani
Mohamad El Labban, Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Juliet Kotys, Sabrina Makher, Sai Shanmukha Sreeram Pannala, Department of Internal Medicine, Staten Island University Hospital, New York, NY 10305, United States
Khalil El Gharib, Department of Pulmonary/Critical Care Medicine, Rutgers Robert Wood Johson Medical School, New Brunswick, NJ 08901, United States
Hamed Chehab, Department of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Liliane Deeb, Department of Pulmonary and Critical Care Medicine, Staten Island University Hospital, New York, NY 10305, United States
Salim R Surani, Department of Medicine & Pharmacology, Texas A & M University, College Station, TX 77843, United States
Co-first authors: Mohamad El Labban and Juliet Kotys.
Author contributions: El Labban M and Kotys J generated the conceptualization and methodology, they contributed equally as co-first authors; El Labban M prepared the software, formal analysis, and data curation; El Labban M, Kotys J, Makher S, Pannala SSS, El Gharib K, Chehab H, Deeb L wrote the original draft; El Labban M, El Gharib K, and Surani SR reviewed and edited the manuscript; El Labban M, El Gharib K, Chehab H, Deeb L, and Surani SR supervised the project.
Institutional review board statement: The National Inpatient Sample dataset is deidentified and publicly available, making it exempt from review by the institutional review boards according to Federal Regulations 45 CFR 46.101 (b).
Informed consent statement: Patients were not required to provide informed consent for this study because this was a study based on publicly available deidentified datasets.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data corresponding to the study are available upon request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Salim R Surani, Department of Medicine & Pharmacology, Texas A & M University, 1248 TAMU, College Station, TX 77843, United States.
surani@tamu.edu
Received: October 14, 2024
Revised: November 1, 2024
Accepted: December 6, 2024
Published online: January 27, 2025
Processing time: 84 Days and 19.7 Hours
BACKGROUND
Necrotizing fasciitis (NF) is a potentially fatal bacterial infection of the soft tissues. Liver cirrhosis appears to be a contributing factor to higher morbidity and mortality in patients with NF. This research article explores the relationship between these two conditions.
AIM
To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF, focusing on inpatient mortality, septic shock, length of stay, and hospital costs.
METHODS
This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample. Cases were identified as patients with both NF and cirrhosis, while controls were non-cirrhotic. The study focused on inpatient mortality as the primary outcome, with secondary outcomes including surgical limb amputation, mechanical ventilation rates, septic shock, length of stay, and hospital costs.
RESULTS
A total of 14920 patients were admitted to the hospital for management of NF, of which 2.11% had liver cirrhosis. Inpatient mortality was higher in cirrhotic patients (9.5% vs 3%; adjusted odds ratio = 3.78; P value = 0.02). Cirrhotic patients also had higher rates of septic shock (10.5% vs 4.9%, P value < 0.01). Length of hospital stay, total charges, and rates of mechanical ventilation were not statistically different between groups.
CONCLUSION
Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF. Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.
Core Tip: This study highlights liver cirrhosis as an independent risk factor contributing to increased mortality and morbidity in patients with necrotizing fasciitis. Patients with cirrhosis who develop necrotizing fasciitis experience markedly higher rates of inpatient mortality and septic shock compared to those without cirrhosis. These findings emphasize the critical need for clinicians to identify and address this association early, aiming to optimize management strategies and improve overall patient outcomes in this vulnerable population.
