Prediction of mortality in necrotizing fasciitis: comparative evaluation of established prognostic scores and a novel scoring system in a retrospective cohort

BACKGROUND: Necrotizing fasciitis (NF) is a rare but serious surgical emergency that progresses rapidly, requires urgent operative intervention, and carries a high mortality rate. Current prognostic scoring systems may have limited predictive power for mortality across different patient groups. The aim of this study was to identify clinical, laboratory, and radiological factors associated with mortality in patients with necrotizing fasciitis. In addition, the study aimed to provide a foundation for the development of a practical prognostic scoring system that could support early risk stratification in clinical practice.
METHODS: This retrospective cohort study examined data from 65 patients diagnosed with NF between January 2021 and December 2024. A modified scoring system was created by integrating the Charlson Comorbidity Index and the total body surface area ratio (Samsun Charlson Comorbidity Index, SaCCI). Sarcopenia was assessed using the psoas muscle index. Using receiver operating characteristic (ROC) analysis, the mortality predictive performance of the modified scoring system was calculated and compared with existing systems.
RESULTS: The SaCCI score demonstrated higher prognostic accuracy than existing systems in predicting mortality, achieving the highest discriminatory power with an area under the curve (AUC) of 0.885. Higher SaCCI scores were associated with a significantly increased risk of mortality. Sarcopenia and delayed surgical intervention were also associated with mortality.
CONCLUSION: The SaCCI score shows promise as an effective tool for predicting early mortality risk in patients with necrotizing fasciitis. The validity of this scoring system, which may inform clinical decision-making, should be confirmed by further multicenter studies.

Keywords: Necrotizing fasciitis, prognosis, sarcopenia, body surface area, risk assessment.

Nekrotizan fasiitte mortalite öngörüsü: Mevcut prognostik skorlarýn ve yeni bir skorlama sisteminin retrospektif kohortta karþýlaþtýrmalý deðerlendirmesi

AMAÇ: Nekrotizan fasiit (NF), hýzlý ilerleyen, acil cerrahi müdahale gerektiren ve yüksek mortalite riski taþýyan nadir fakat ciddi bir cerrahi acildir. Mevcut prognostik skorlama sistemleri, farklý hasta gruplarýnda mortaliteyi öngörmede sýnýrlý kalabilmektedir. Bu çalýþmanýn amacý, nekrotizan fasiitli hastalarda mortalite ile iliþkili klinik, laboratuvar ve radyolojik faktörleri belirlemekti. Ayrýca, elde edilen bulgular doðrultusunda, klinik uygulamalarda erken risk sýnýflamasýna katký saðlayabilecek pratik bir prognostik skorlama sistemi geliþtirilmesine temel oluþturmak hedeflenmiþtir.
GEREÇ VE YÖNTEM: Bu retrospektif kohort çalýþmada, Ocak 2021 ile Aralýk 2024 arasýnda, NF tanýsý alan 65 hastanýn verileri incelenmiþtir. Charlson Komorbidite Ýndeksi ile total vücut yüzey alaný oraný entegre edilerek modifiye bir skorlama sistemi (Samsun Charlson Komorbidite Ýndeksi – SaCCI) oluþturulmuþtur. Sarkopeni, psoas kas indeksi (PMI) ile deðerlendirilmiþtir. ROC analizi kullanýlarak mortaliteyi öngörme performansý hesaplanmýþ ve mevcut skorlarla karþýlaþtýrýlmýþtýr.
BULGULAR: SaCCI skoru, mortaliteyi öngörmede mevcut sistemlere kýyasla daha yüksek prognostik doðruluk göstermiþtir. ROC analizinde en yüksek ayýrt edici güce ulaþarak AUC deðeri 0.885 bulunmuþtur. Yüksek SaCCI skorlarý, anlamlý þekilde artmýþ mortalite riski ile iliþkilendirilmiþtir. Ayrýca sarkopeni ve gecikmiþ cerrahi müdahale de mortalite ile iliþkili bulunmuþtur.
SONUÇ: SaCCI skoru, nekrotizan fasiitli hastalarda mortalite riskini erken öngörmede etkili bir araç olma potansiyeli taþýmaktadýr. Klinik karar süreçlerine katký saðlayabilecek bu skorlama sisteminin geçerliliði, çok merkezli ileri çalýþmalarla teyit edilmelidir.

Anahtar Kelimeler: Nekrotizan fasiit, prognostik deðerlendirme, risk sýnýflamasý, sarkopeni, vücut yüzey alaný.