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Marcadores bioquímicos de riesgo para mortalidad por fascitis necrotizante
Resumen
Objetivo: identificar si anemia, hipoalbuminemia, hipocalcemia, valores elevados de creatinfosfocinasa e hipoprotrombinemia, son marcadores de riesgo para mortalidad en fascitis necrotizante de acuerdo al sitio anatómico de inicio y superficie corporal afectada.
Material y métodos: diseño de casos y controles en una cohorte prospectiva. Se documentó edad, factores causales asociados, localización de la infección, superficie corporal afectada, datos del laboratorio, gérmenes hallados, tratamiento y evolución. Dos grupos de pacientes: fallecidos y sobrevivientes, estratificados en seis subgrupos de acuerdo al sitio anatómico.
Resultados: se incluyeron 394 pacientes; 252 hombres y 142 mujeres, edad media de 52.8 años. Subgrupos: extremidades (n = 113), genital masculino (n = 103); tórax y abdomen (n = 64); cabeza, cuello y parte superior de tórax (n = 44); genitales femeninos, periné e ingle (n = 42); sacro y glúteos (n = 28). Hipoalbuminemia (OR = 3.8, IC 95 % = 1.5-9.5, p < 0.000), hipocalcemia (OR = 5.7, IC 95 % = 3.2-9.9, p = 0.030), creatinfosfocinasa elevada (OR = 1.5, IC 95 % = 1.0-2.4, p < 0.000) y anemia (OR = 4.4, IC 95 % = 2.8-6.9, p < 0.000), se asociaron a mortalidad. Albúmina (OR = 3.8, IC = 1.5-8.9), protrombina (OR = 6.6, IC 95 % = 3.6-19.5) y tiempo de evolución (OR = 5.2, IC 95 % = 1.2-8.3) mostraron p < 0.05.
Conclusiones: hipocalcemia, hipoprotrombinemia, anemia, creatinfosfocinasa elevada y tiempo de evolución sugieren ser marcadores de riesgo para mortalidad en fascitis necrotizante.
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Defore WW Jr, Mattox KL, Dang MH, Crawford R, Jordan GL Jr. Necrotizing fasciitis: a persistent surgical problem. JACEP 1977;6:62-65.
Brandt MM, Corpron CA, Wahl WL. Necrotizing soft tissue infections: a surgical disease. Am Surg 2000;66:967-970.
Varma R, Stashower ME. Necrotizing fasciitis: delay in diagnosis results in loss of limb. Int J Dermatol 2006; 45:1222-1223.
Smeets L, Bous A, Lecoq J, Damas P, Heymans O. [Necrotizing fasciitis: diagnosis and treatments]. Rev Med Liege 2006;61:240-244.
Carter PS, Banwell PE. Necrotizing fasciitis: a new management algorithm based on clinical classification. Int Wound J 2004;1:189-198.
Banwell PE, Bovill E, Carter P, Ahmed S. Diagnosing necrotizing fasciitis. J Wound Care 2005;14: 110-111.
Ozalay M, Ozkoc G, Akpinar S, Hersekli MA, Tandogan RN. Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality. Foot Ankle Int 2006;27:598-605.
McGee EJ. Necrotizing fasciitis: review of pathophysiology, diagnosis, and treatment. Crit Care Nurs Q 2005;28:80-84.
Mehta S, McGeer A, Low DE, Hallett D, Bowman DJ, Grossman SL, Stewart TE. Morbidity and mortality of patients with invasive group A streptococcal infections admitted to the ICU. Chest 2006; 130:1679-1686.
Pessa ME, Howard RJ. Necrotizing fasciitis. Surg Gynecol Obstet 1985;161:357-361.
Prakash PK, Biswas M, ElBouri K, Braithwaite PA, Hanna FW. Pneumococcal necrotizing fasciitis in a patient with type 2 diabetes. Diabet Med 2003; 20:899-903.
Ahmed I, Goldstein B. Diabetes mellitus. Clin Dermatol 2006;24:237-246.
Mundigler G, Geppert A, Henk C, Girsch W, Siostrzonek P. Extensive necrotizing fasciitis in a diabetic patient. Wien Klin Wochenschr 1998; 110: 446-448.
Andriescu L, Danila R, Badic B, Radulescu C, Dragomir C, Tamas C, et al. [Necrotizing fasciitis]. Chirurgia 2005;100: 391-393.
Wong TY. A nationwide survey of deaths from oral and maxillofacial infections: the Taiwanese experience. J Oral Maxillofac Surg 1999; 57:1297-1299.
Hoeffel F, Hoeffel C. [Necrotizing fasciitis. Risk for the elderly is especially great]. MMW Fortschr Med 2001;143:10.
Graves C, Saffle J, Morris S, Stauffer T, Edelman L. Caloric requirements in patients with necrotizing fasciitis. Burns 2005;31:55-59.
Hanish SI, Petersen RP, Collins BH, Tuttle-Newhall J, Marroquin CE, Kuo PC, et al. Obesity predicts increased overall complications following pancreas transplantation. Transplant Proc 2005; 37:3564-3566.
Gauzit R. [Necrotizing skin and soft tissue infections: definitions, clinical and microbiological features]. Ann Fr Anesth Reanim 2006; 25:967-970.
Kihiczak GG, Schwartz RA, Kapila R. Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol 2006;20:365-369.
Schroeder JL, Steinke EE. Necrotizing fasciitis —the importance of early diagnosis and debridement. AORN J 2005;82:1031-1040.
Jeong HJ, Park SC, Seo IY, Rim JS. Prognostic factors in Fournier gangrene. Int J Urol 2005;12: 1041-1044.
McHenry CR, Brandt CP, Piotrowski JJ, Jacobs DG, Malangoni MA. Idiopathic necrotizing fasciitis: recognition, incidence, and outcome of therapy. Am Surg 1994;60:490-494.
Heitmann C, Pelzer M, Bickert B, Menke H, Germann G. [Surgical concepts and results in necrotizing fasciitis]. Chirurg 2001;72:168-173.
Sheridan R TR. Evaluation and management of the thermally injured patient. En: Fitzpatrick’s dermatology in general medicine. New York: McGraw-Hill; 1999. p. 1505-14.
Baer W, Schaller P, Ruf S, Lehn N, Lerch K. [Diagnosis and therapy of necrotizing fasciitis]. Orthopade 2002;31:551-555.
Endorf FW, Supple KG, Gamelli RL. The evolving characteristics and care of necrotizing soft-tissue infections. Burns 2005;31:269-273.
Nakamura S, Hashimoto Y, Ishida-Yamamoto A, Takahashi H, Yokoo H, Ichikawa H, et al. Hypocalcemia: a sign of severity of necrotizing fasciitis. Dermatology 2004; 209:64-65.
Wyrick WJ Jr, Rea WJ. Necrotizing fasciitis. Rev Surg 1971;28:143.
Simonart T, Nakafusa J, Narisawa Y. The importance of serum creatine phosphokinase level in the early diagnosis and microbiological evaluation of necrotizing fasciitis. J Eur Acad Dermatol Venereol 2004; 18:687-690.
Nakafusa J, Misago N, Miura Y, Kayaba M, Tanaka T, Narisawa Y. The importance of serum creatine phosphokinase level in the early diagnosis, and as a prognostic factor, of Vibrio vulnificus infection. Br J Dermatol 2001;145:280-284.
Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-1541.
Wong CH, Khin LW. Clinical relevance of the LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score for assessment of early necrotizing fasciitis. Crit Care Med 2005;33:1677.
Rea WJ, Wyrick WJ, Jr. Necrotizing fasciitis. Ann Surg 1970;172:957-964.
Sudarsky LA, Laschinger JC, Coppa GF, Spencer FC. Improved results from a standardized approach in treating patients with necrotizing fasciitis. Ann Surg 1987;206:661-665.
Baier P, Imdahl A. [Necrotizing fasciitis. Only radical debridement helps here]. MMW Fortschr Med 2001;143:26-27.
Brun-Buisson C. [The therapeutic approach to necrotizing fasciitis]. Ann Dermatol Venereol 2001; 128:394-403.
Fontes RA, Jr., Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg 2000;8:151-158.
Patino JF, Castro D. Necrotizing lesions of soft tissues: a review. World J Surg 1991;15:235-239.
Taviloglu K, Cabioglu N, Cagatay A, Yanar H, Ertekin C, Baspinar I, et al. Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg 2005;71:315-320.
Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, et al. Fournier’s Gangrene: risk factors and strategies for management. World J Surg 2006;30:1750-17.
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