Effect of Connective Tissue Disorders on Outcomes in Patients with Necrotizing Soft Tissue Infections

INTRODUCTION: Necrotizing soft tissue infections (NSTI) are rapidly progressive, life-threatening infections associated with high morbidity and mortality. NSTI patients with systemic connective tissue disorders (CTD), such as systemic lupus erythematosus (SLE), may be at increased risk of poor perioperative outcomes given the multisystemic, inflammatory nature of the disease processes. We aimed to determine if CTD is a predictor of outcomes in the surgical management of NSTI. METHODS: We conducted a retrospective review of patients with NSTI and CTD, specifically SLE, from the National Inpatient Sample. Primary outcomes were in-hospital mortality, length of stay, and number of operative debridements. Multivariable regression was used to determine association between patients with CTD and patient outcomes. RESULTS: Of 119,799 patients with NSTI, 2,490 (2.1%) had CTD, and 545 (0.5%) had SLE. The mean age was 55.4 years, and 35% were female. After adjusting for patient and hospital characteristics, CTD trended toward increased mortality but was nonsignificant (odds ratio 1.3, 95% CI 1.0 to 1.8, p = 0.054), and SLE specifically was associated with 2.5 times higher odds of mortality (95% CI 1.4 to 4.2). CTD was associated with 1.5 fewer hospital days (95% CI –2.7 to –0.4) but was not associated with number of operative debridements (IRR 1.1, 95% CI 1.0 to 1.2). CONCLUSION: In patients with NSTI, those with SLE had a 2-fold increased odds of death. Patients with CTD are predisposed to infections, and if they develop NSTIs, they may be susceptible to catastrophic outcomes. Further exploration into the pathophysiology of this association is warranted to reduce mortality risk in this vulnerable population.