RESUMO
Background: Necrotizing fasciitis (NF) can affect any soft tissue and skin of the body. Its progression is rapid and it is associated with a high mortality rate. Therefore, the search for easily accessible and low-cost biomarkers that could predict the prognosis of patients with NF is necessary. Objective: To evaluate the role of neutrophil-lymphocyte ratio (NLR) as a predictor of mortality in patients with NF. Material and methods: Observational, cross-sectional, retrospective and analytical study of patients admitted between April and October 2020 in a tertiary-care hospital. The statistical tests used for the comparison of variables between the study groups were chi-square, Fisher's exact, Student's t and Mann-Whitney U. A receiver operating characteristic (ROC) curve was performed to determine the accuracy of NLR in predicting mortality in patients with NF. Results: A total of 25 patients were included and stratified into non-survivors and survivors. The non-survivor group had an elevated NLR value compared to survivors (15.57 [13.75] vs. 7.91 [4.13]; p = 0.065). The NLR had an area under the curve (AUC) of 0.729 (95% confidence interval [95% CI] 0.516-0.886; p = 0.044), sensitivity of 77.78% (40-97.2), and specificity of 75% (47.6-92.7). The optimal cut-off point obtained for NLR was > 9.21. Conclusions: An NLR value > 9.21 could be a predictor of mortality in patients with NF.
Introducción: la fascitis necrotizante (FN) puede afectar cualquier tejido blando y piel del cuerpo. Su progresión es rápida y está relacionada con un índice de mortalidad alto. Por lo tanto, la búsqueda de biomarcadores de fácil acceso y bajo costo que puedan predecir el pronóstico de los pacientes con FN es necesaria. Objetivo: evaluar el papel del índice neutrofilo-linfocito (INL) como un predictor de mortalidad en los pacientes con FN. Material y métodos: estudio observacional, transversal, retrospectivo y analítico de pacientes admitidos entre abril y octubre del 2020 en un hospital de tercer nivel. Las pruebas estadísticas utilizadas para la comparación de las variables entre los grupos de estudio fueron chi cuadrado, exacta de Fisher, t de Student y U de Mann-Whitney. Una curva característica operativa del receptor (ROC) fue realizada para determinar la precisión del INL en la predicción de mortalidad en pacientes con FN. Resultados: un total de 25 pacientes fueron incluidos y estratificados en no sobrevivientes y sobrevivientes. El grupo no sobreviviente tuvo un valor elevado del INL en comparación con los sobrevivientes (15.57 [13.75] frente a 7.91 [4.13]; p = 0.065). El INL tuvo un área bajo la curva (AUC) de 0.729 (intervalo de confianza del 95% [IC 95%] 0.516-0.886; p = 0.044), sensibilidad de 77.78% (40-97.2) y especificidad de 75% (47.6-92.7). El punto de corte óptimo obtenido para el INL fue > 9.21. Conclusiones: un valor de INL > 9.21 podría ser un predictor de mortalidad en los pacientes con FN.
Assuntos
Fasciite Necrosante , Linfócitos , Neutrófilos , Humanos , Fasciite Necrosante/mortalidade , Fasciite Necrosante/sangue , Fasciite Necrosante/diagnóstico , Masculino , Estudos Retrospectivos , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Prognóstico , Adulto , Idoso , Curva ROC , Contagem de Linfócitos , Valor Preditivo dos Testes , Biomarcadores/sangueRESUMO
BACKGROUND: In December 2019, an outbreak of a novel coronavirus (COVID-19) occurred in China and became pandemic in March 2020. Patients undergoing surgery are a vulnerable risk of COVID-19 exposure/infection. The aim of the study was to determine the characteristics and outcomes of patients undergoing surgery during the COVID-19 pandemic in a third level reference hospital in Mexico. METHOD: IRB approved observational study (prospectively collected database) of general and surgical oncology procedures from 04/20-08/20. Patients preoperative data and surgical cases registered. COVID-19 detection was a combination of polymerase chain reaction swab and chest computed tomography. Primary endpoints were: 30 d surgical mortality and complications, including COVID-19 infection during hospitalization. RESULTS: 193 patients were included (mean age: 53.9 years, 63.7% female). 52.8% procedures were performed by surgical oncology. 42.4% developed a complication with 8.3% mortality. COVID-19 infection was 11.3% (nâ¯=â¯22). Postoperative morbidity (81.3 vs. 37.4%, pâ¯=â¯0.0001) and mortality (27.3 vs. 5.8%, pâ¯=â¯0.0001) was higher in COVID-19 (+) patients. Factors associated with COVID-19 infections were sex, functional status, preoperative sepsis and ventilation, renal failure and dialysis (univariate analysis) and sepsis and renal failure (multivariate analysis). COVID-19 infection was associated with respiratory complications (54.5 vs. 2.9%), surgical site infection (27.3 vs. 10.5%), postoperative transfusions (59.1 vs. 31.6%), renal failure (54.5 vs. 8.2%), sepsis (68.2 vs. 22.2%), reintervention (22.7 vs. 7.6%), readmission (18.2 vs. 4.1%), and death (27.3 vs. 5.8%) (p <0.05). CONCLUSION: Postoperative morbidity and mortality in COVID-19 patients is high. Surgical procedures should be thoughtfully reviewed with a plan to minimize scheduled operations.