The characteristics of oro-cervical necrotizing fasciitis—Comparison with severe cellulitis of oro-cervical region and necrotizing fasciitis of other body regions

• DOI: 10.1371/journal.pone.0260740
• Publication Date: 2021-12-01T18:31:20Z
• Authors: Eiji Iwata; Junya Kusumoto; Naoki Takata; Shungo Furudoi; Akira Tachibana; Masaya Akashi
• Keywords: Adult; Male; Neutrophils; Science; 03 medical and health sciences; 0302 clinical medicine; Humans; Fasciitis, Necrotizing; Lymphocyte Count; Aged; Aged, 80 and over; Mouth; Q; R; Patient Acuity; Cellulitis; Middle Aged; Prognosis; Survival Analysis; 3. Good health; Multivariate Analysis; Medicine; Female; Biomarkers; Neck; Research Article

Background Necrotizing fasciitis (NF) is an acute and life-threatening soft-tissue infection however rarely seen in oro-cervical region. Therefore, the details of oro-cervical NF (OCNF) are not well known. The purpose of this study was to investigate the characteristics of OCNF by comparing it with severe cellulitis of oro-cervical region (OCSC) or NF of other body regions (e.g., limb, perineum, and trunk) (BNF), respectively.

Materials and methods At first, various risk factors for OCNF in oro-cervical severe infection (OCSI; composed of OCNF and OCSC), including neutrophil-to-lymphocyte ratio (NLR) and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, were investigated by univariate and multivariate analyses. Next, the differences between OCNF and BNF, including inflammatory markers and mortality, were investigated.

Results In the present study, 14 out of 231 OCSI patients had OCNF. Multivariate analyses of OCSI patients showed that NLR ≥15.3 and LRINEC score ≥6 points were significantly related to OCNF. During the same period, 17 patients had BNF. The OCNF group had significantly higher inflammatory markers than the BNF group when diagnosis, but significantly lower clinical stages at the time and mortality as outcomes.

Conclusion We found that compared to BNF, OCNF can be detected at lower clinical stage by using indexes, such as NLR and LRINEC score, besides clinical findings, which may help contributing to patient’s relief.