Age and Blood Creatinine Predict Mortality in Necrotizing Soft Tissue Infections
Necrotizing soft tissue infections are serious and rare conditions that rapidly destroy tissue and cause severe systemic inflammation. They can affect any part of the body but most commonly manifest in the limbs or trunk. Fournier’s gangrene, a particularly aggressive form, affects the genital and perineal regions, primarily in men. These infections can be caused by a single bacterium, such as streptococcus, or by multiple microorganisms simultaneously, combining aerobic and anaerobic bacteria.
Despite advances in intensive care and surgical management, these infections remain associated with a high mortality rate, reaching up to 45%, and even exceeding 50% in cases of single or multiple organ failure. Their rapid progression—sometimes several centimeters per hour—makes early diagnosis essential. However, the initial clinical signs are often non-specific and can be confused with those of more common infections, frequently delaying diagnosis.
A recent study conducted in four university hospitals in Italy analyzed data from 379 adult patients with surgically confirmed necrotizing soft tissue infections between 2010 and 2024. Researchers examined various factors available upon hospital admission, such as age, medical history, vital signs, and blood test results. The goal was to identify variables associated with an increased risk of death during hospitalization.
The results show that 16.7% of patients died in the hospital. Among the subgroups studied, mortality was 17% for necrotizing fasciitis of the limbs and 22.4% for Fournier’s gangrene. Age and blood creatinine levels at admission were the only two factors independently associated with an increased risk of mortality. Specifically, each additional year of age slightly increased the risk, while high creatinine levels—reflecting preexisting kidney failure or acute kidney injury—were also linked to a fatal outcome. Creatinine is a waste product produced by muscles and eliminated by the kidneys, and its accumulation in the blood signals kidney dysfunction.
In patients with necrotizing fasciitis of the limbs, age and a history of chronic kidney disease remained the only independent predictors of mortality. For Fournier’s gangrene, only age was independently associated with death. Although these subgroup analyses were limited by a small number of events, they confirm that older patients have a poorer prognosis.
A graphical tool, called a nomogram, was developed to help physicians quickly assess the risk of death based on age and creatinine levels. This tool demonstrated a good ability to distinguish between high-risk and low-risk patients, with a close match between predictions and actual outcomes. This could facilitate early decision-making, such as referral to intensive care or the adoption of more aggressive therapeutic strategies.
Necrotizing soft tissue infections require rapid surgical intervention to remove infected tissue, combined with broad-spectrum antibiotic therapy. Despite these treatments, survivors may suffer significant sequelae, such as amputations or long-term functional disabilities, affecting their quality of life. This study highlights that age and renal status at admission are key indicators for assessing patient prognosis, although further research is needed to refine these predictions.
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Original Publication
DOI: https://doi.org/10.1007/s00068-026-03242-0
Title: Factors associated with in-hospital mortality in necrotising soft tissue infections. a multicentre retrospective cohort study
Journal: European Journal of Trauma and Emergency Surgery
Publisher: Springer Science and Business Media LLC
Authors: Mauro Podda; Marco Ceresoli; Francesco Virdis; Fausto Rosa; Tiziana Pilia; Valentina Murzi; Alessia Dessì; Silvia Tedesco; Caterina Cina; Pasquale Chiacchio; Carla Vitiello; Emilio Paolo Emma; Stefano Piero Bernardo Cioffi; Michele Altomare; Stefania Cimbanassi; Adolfo Pisanu