A Cross-Sectional Comparative Study of Prognostic Outcome of Necrotizing Fasciitis in Patients with and Without Diabetes Mellitus at a Tertiary Care Hospital

Abstract

Background: Necrotizing fasciitis is a rapidly progressive soft tissue infection associated with high morbidity and mortality. Diabetes mellitus is a well-recognized predisposing factor; however, its influence on prognostic outcomes remains incompletely understood. This study compared the clinical profile and prognostic outcomes of necrotizing fasciitis in diabetic and non-diabetic patients treated at a tertiary care hospital. Objectives: To compare the demographic characteristics, clinical presentation, laboratory findings, microbiological profile, treatment modalities, complications, hospital course, and prognostic outcomes of necrotizing fasciitis between diabetic and non-diabetic patients. Material & Methods: A hospital-based cross-sectional comparative study was conducted over 18 months in the Department of General Surgery at a tertiary care teaching hospital. Ninety-six adult patients diagnosed with necrotizing fasciitis were enrolled using consecutive sampling and equally divided into diabetic (n=48) and non-diabetic (n=48) groups. Demographic characteristics, clinical features, laboratory parameters, microbiological findings, treatment modalities, complications, duration of hospitalization, intensive care unit admission, and mortality were recorded prospectively. Statistical analysis was performed using IBM SPSS. Continuous variables were compared using Student's t-test, while categorical variables were analyzed using the Chi-square test. Multivariate logistic regression was performed to identify independent predictors of poor outcome. A p value <0.05 was considered statistically significant. Results: The mean age was comparable between diabetic and non-diabetic patients (44.77±14.43 vs. 45.04±15.12 years; p=0.929), with male predominance in both groups. Lower limb involvement was the commonest anatomical site. Pain was the most frequent presenting symptom, while swelling was significantly more common among diabetic patients (89.6% vs. 72.9%; p=0.033). Random blood glucose levels were significantly higher in diabetic patients (270.77±48.29 vs. 125.93±18.56 mg/dL; p<0.001), whereas other laboratory parameters and microbiological profiles were comparable. Treatment modalities, number of debridements, duration of hospital stay, ICU admission, and mortality did not differ significantly between groups. Multi-organ dysfunction syndrome occurred significantly more frequently among diabetic patients (41.7% vs. 20.8%; p=0.023). Multivariate analysis demonstrated that diabetes mellitus was not an independent predictor of poor outcome. Conclusion: Diabetes mellitus was associated with greater disease severity, reflected by a significantly higher incidence of multi-organ dysfunction syndrome, but did not independently influence mortality or overall treatment outcome when patients received timely surgical intervention and standardized multidisciplinary care. Early diagnosis, prompt aggressive debridement, appropriate antimicrobial therapy, and intensive supportive management remain the principal determinants of favourable outcomes in necrotizing fasciitis.