Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-58437

Prediction of Mortality in Necrotising Fasciitis: Comparative Evaluation of Established Prognostic Scores and a Novel Scoring System in a Retrospective Cohort

Can Akgün¹, Mehmet Alperen Avcý¹, Mustafa Gün¹, Ýlkem Duman², Mesut Öztürk³, Bülent Koca^4
1Samsun University Faculty of Medicine, Department of General Surgery
²Samsun Provincial Health Directorate
³Samsun University Faculty of Medicine, Department of Radiology
⁴Tokat Gaziosmanpaþa University Faculty of Medicine, Department of General Surgery,

Background

Necrotising 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 in different patient groups. The aim of this study was to identify clinical, laboratory, and radiological factors associated with mortality in patients with necrotising 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 the data of 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 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 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 necrotising fasciitis. The validity of this scoring system, which can inform clinical decisions, should be confirmed by further multicenter studies.

Keywords: Necrotising Fasciitis, Prognosis, Sarcopenia, Body Surface Area, Risk Assessment

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Nekrotizan Fasiitte Mortalite Öngörüsü: Mevcut Prognostik Skorlarýn ve Yeni Bir Skorlama Sisteminin Retrospektif Kohortta Karþýlaþtýrmalý Deðerlendirmesi

Can Akgün¹, Mehmet Alperen Avcý¹, Mustafa Gün¹, Ýlkem Duman², Mesut Öztürk³, Bülent Koca^4
1Samsun Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý
²Samsun Ýl Saðlýk Müdürlüðü
³Samsun Üniversitesi Týp Fakültesi, Radyoloji Anabilim Dalý
⁴Tokat Gaziosmanpaþa Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý

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, Sarkopeni, Vücut Yüzey Alaný, Risk Sýnýflamasý

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