Liver cirrhosis as a real risk factor for necrotising fasciitis: a three-year population-based follow-up study

Hung TH, Tsai CC, Tsai CC, Tseng CW, Hsieh YH
Correspondence:  Dr Yu-Hsi Hsieh, hsieh.yuhsi@msa.hinet.net

ABSTRACT
INTRODUCTION Necrotising fasciitis (NF) is often found in patients with diabetes mellitus, chronic renal failure, alcoholism, malignancy or liver cirrhosis. However, it remains unknown whether liver cirrhosis is an independent risk factor for the occurrence of NF. This study aimed to determine whether liver cirrhosis is an independent risk factor for the occurrence of NF, and to identify the relationship between severity of liver cirrhosis and occurrence of NF.
METHODS The National Health Insurance Research Database, maintained by Taiwan’s National Health Insurance programme, was retrospectively analysed, and the hospitalisation data of 40,802 cirrhotic patients and 40,865 randomly selected, age? and gender?matched non?cirrhotic control patients was collected. The medical records of all patients were individually followed for a three?year period from the patients’ first hospitalisation in 2004.
RESULTS During the three?year follow?up period, there were 299 (0.7%) cirrhotic patients with NF and 160 (0.4%) non?cirrhotic patients with NF. Cox regression analysis showed that liver cirrhosis was a risk factor for the occurrence of NF during the study period (hazard ratio 1.982; p < 0.001). Among cirrhotic patients, those with complicated liver cirrhosis had a higher risk for the occurrence of NF than patients with non?complicated liver cirrhosis (hazard ratio 1.320; p = 0.028).
CONCLUSION Cirrhotic patients had a higher risk for the occurrence of NF than non?cirrhotic patients, and the risk for NF was especially high among patients with complicated liver cirrhosis.

Keywords: cirrhosis, complicated liver cirrhosis, necrotising fasciitis
Singapore Med J 2014; 55(7): 378-382; http://dx.doi.org/10.11622/smedj.2014090

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