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Year : 2021  |  Volume : 54  |  Issue : 5  |  Page : 203

Factors influencing the outcome of necrotizing fasciitis

Department of Surgery, Division of Vascular and Endovascular Surgery, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Date of Submission07-Apr-2021
Date of Acceptance20-May-2021
Date of Web Publication12-Oct-2021

Correspondence Address:
Fachreza Aryo Damara
Dr Cipto Mangunkusumo Hospital, 71st Diponegoro, Jakarta
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/fjs.fjs_70_21

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How to cite this article:
Damara FA, Pratama D. Factors influencing the outcome of necrotizing fasciitis. Formos J Surg 2021;54:203

How to cite this URL:
Damara FA, Pratama D. Factors influencing the outcome of necrotizing fasciitis. Formos J Surg [serial online] 2021 [cited 2021 Nov 28];54:203. Available from: https://www.e-fjs.org/text.asp?2021/54/5/203/327888

Dear Editor,

We have read with great interest an original article entitled, “Predictors of mortality in necrotizing fasciitis” by Kumar and Lal in a recent issue at Formosan Journal of Surgery (2021; 54: 52–60).[1] We would like to congratulate the authors for their incredible work and contributions.

Necrotizing fasciitis (NF) is a diagnosis involving skin and soft tissue infections that commonly requires immediate definitive surgical intervention.[2],[3] As a consequence, recognizing risk factors that may attribute to poor outcomes in an early encounter is important to acknowledge physicians to understand the disease progressivity. Several prior studies have been conducted to extensively analyze early signs that can be obtained from history-taking, physical examination, and laboratory results. Apart from the importance of this study – providing the study results from another study setting's perspective, there are other components of predictors that should be further discussed in this study.

The authors discussed several physical and laboratory examination findings and their influence on mortality rate. However, the study findings did not include hemorrhagic bullae in its analysis. The presence of bullae differentiates NF from other skin and soft tissue infections.[4] A previous meta-analysis involving 23 studies indicates that hemorrhagic bullae was associated with NF with a sensitivity of 25.2% (95% confidence interval [CI] 12.8%–43.7%) and specificity of 95.8% (95% CI 87.3%–98.7%).[2] Therefore, that the presence of hemorrhagic bullae should be included in the analysis to understand whether it influences NF mortality in the study.

In addition, choosing the effect measure in the study is essential to provide clinicians with an accurate statistical interpretation that will be translated into the clinical practice. As this study provides important findings to take the results into account in better predicting patient mortality, presenting the value of sensitivity and specificity of several most influencing factors is needed. Further, although the authors have stated the P value of univariate and multivariate regression analyses, the value of odd ratio as an effect measure ought to be included to provide another value for researchers who are conducting a secondary study to investigate these factors.

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There are no conflicts of interest.

  References Top

Kumar M, Lal M. Predictors of mortality in necrotizing fasciitis. Formosan J Surg 2021;54:52-60.  Back to cited text no. 1
Fernando SM, Tran A, Cheng W, Rochwerg B, Kyeremanteng K, Seely AJE, et al. Necrotizing soft tissue infection: Diagnostic accuracy of physical examination, imaging, and LRINEC score: A systematic review and meta-analysis. Ann Surg 2019;269:58-65.  Back to cited text no. 2
Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC. Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med 2008;26:170-5.  Back to cited text no. 3
McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221:558-63.  Back to cited text no. 4


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