{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:55:31Z","timestamp":1791186931579,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Necrotizing fasciitis (NF) is a rapidly progressive, life\u2010threatening infection, with the lower limbs being a common site. Diabetes mellitus (DM) is a significant risk factor that influences the progression, outcome, and management of NF. Despite its clinical relevance, comparative data on diabetic versus non\u2010diabetic NF outcomes remain limited. This study aimed to compare mortality, amputation rates, and other key outcomes between diabetic and non\u2010diabetic patients with NF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis were conducted in accordance with PRISMA guidelines. Eligible studies assessed outcomes in diabetic and non\u2010diabetic NF patients. Primary outcome measures included amputation rates, mortality, admission length, debridement frequency, and microbial growth. Secondary outcomes included the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and unplanned reoperations. Pooled analyses were performed using OpenMeta[Analyst] software, reporting odds ratios (OR) and mean differences (MD) with 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies comprising 1,890 patients met the inclusion criteria. Diabetic patients had significantly higher rates of amputation (OR 3.77, 95% CI 3.04 to 4.68;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and polymicrobial infections (OR 2.53, 95% CI 1.50 to 4.26;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Mortality was higher among diabetic patients after sensitivity analysis (OR 1.60, 95% CI 1.09 to 2.33;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Length of admission did not differ significantly between groups, whereas the pooled number of debridements was marginally higher in diabetic patients (MD 0.28, 95% CI 0.05 to 0.52;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), based on only two studies. Diabetic patients had significantly higher LRINEC scores (MD 2.02, 95% CI 1.33 to 2.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Diabetic patients with NF experience worse clinical outcomes, including increased amputation, mortality, and polymicrobial infection. These findings highlight DM as a key prognostic factor and underscore necessity for aggressive intervention and risk stratification. Further high\u2010quality prospective studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73247","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:17:16Z","timestamp":1789705036000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Necrotizing Fasciitis Outcomes in Diabetic vs Non\u2010Diabetic Patients: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6031-201X","authenticated-orcid":false,"given":"Cameron Alexander","family":"Lynch","sequence":"first","affiliation":[{"name":"Wythenshawe Hospital Manchester Foundation Trust Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0077-3825","authenticated-orcid":false,"given":"Abdiqadir Omar","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Hull University Teaching Hospitals NHS Trust Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7912-1048","authenticated-orcid":false,"given":"Chea Tze","family":"Ong","sequence":"additional","affiliation":[{"name":"Royal Derby Hospital Derby UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2086-4255","authenticated-orcid":false,"given":"Muneeb Ahmad","family":"Khan","sequence":"additional","affiliation":[{"name":"University Hospitals of North Midlands Stoke\u2010on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9590-9895","authenticated-orcid":false,"given":"Mohaned","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Mid Yorkshire NHS Foundation Trust Wakefield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Isuru Hiranya Perera","sequence":"additional","affiliation":[{"name":"Mid and South Essex Hospital Essex UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Roberts","sequence":"additional","affiliation":[{"name":"Hull Royal Infirmary Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Chai","sequence":"additional","affiliation":[{"name":"Hull Royal Infirmary Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1271-2190","authenticated-orcid":false,"given":"Hadeel","family":"Hussein","sequence":"additional","affiliation":[{"name":"Bradford Teaching Hospitals Bradford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5865-4966","authenticated-orcid":false,"given":"Abdal Qadir","family":"Zafar","sequence":"additional","affiliation":[{"name":"Whittington Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shafiq","family":"Rahman","sequence":"additional","affiliation":[{"name":"Hull University Teaching Hospitals NHS Trust Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12262-009-0076-6"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.29840"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2017.00005"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu296"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002774"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.5402\/2012\/942437"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(02)01951-9"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/15347346211041452"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000129486.35458.7D"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znae204"},{"key":"e_1_2_12_12_1","volume-title":"In: StatPearls","author":"Wallace H. 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