{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:38:37Z","timestamp":1787755117645,"version":"build-2784847793"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Necrotizing fasciitis is a rapidly progressive infection with a high mortality rate. Pathogens evade the host containment and bactericidal mechanisms by hijacking the coagulation and inflammation signaling pathways, leading to their rapid dissemination, thrombosis, organ dysfunction, and death. This study examines the hypothesis that measures of immunocoagulopathy upon admission could aid in the identification of patients with necrotizing fasciitis at high risk for in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Demographic data, infection characteristics, and laboratory values from 389 confirmed necrotizing fasciitis cases from a single institution were analyzed. A multivariable logistic regression model was built on admission immunocoagulopathy measures (absolute neutrophil, absolute lymphocyte, and platelet counts) and patient age to predict in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The overall in-hospital mortality rate was 19.8% for the 389 cases and 14.6% for the 261 cases with complete measures of immunocoagulopathy on admission. A multivariable logistic regression model indicated that platelet count was the most important predictor of mortality, followed by age and absolute neutrophil count. Greater age, higher neutrophil count, and lower platelet count led to significantly higher risk of mortality. The model discriminated well between survivors and non-survivors, with an overfitting-corrected C-index of 0.806.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study determined that measures of immunocoagulopathy and patient age at admission effectively prognosticated the in-hospital mortality risk of patients with necrotizing fasciitis. Given the accessibility of neutrophil-to-lymphocyte ratio and platelet count measurements determined from a simple complete blood-cell count with differential, future prospective studies examining the utility of these measures are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.22.00106","type":"journal-article","created":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T14:01:16Z","timestamp":1677592876000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis"],"prefix":"10.2106","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4032-2058","authenticated-orcid":false,"given":"Samuel R.","family":"Johnson","sequence":"first","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9540-4379","authenticated-orcid":false,"given":"Teresa","family":"Benvenuti","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0047-8330","authenticated-orcid":false,"given":"Hui","family":"Nian","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9240-0164","authenticated-orcid":false,"given":"Isaac P.","family":"Thomson","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"},{"name":"Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2333-9061","authenticated-orcid":false,"given":"Keith","family":"Baldwin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, The Children\u2019s Hospital of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8942-1842","authenticated-orcid":false,"given":"William T.","family":"Obremskey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-5496","authenticated-orcid":false,"given":"Jonathan G.","family":"Schoenecker","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee"},{"name":"Division of Pediatric Orthopaedics, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"},{"name":"Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3045-4199","authenticated-orcid":false,"given":"Stephanie N.","family":"Moore-Lotridge","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Division of Pediatric Orthopaedics, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"},{"name":"Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1]]},"reference":[{"issue":"6","key":"R1-20240801","doi-asserted-by":"crossref","first-page":"526","DOI":"10.2106\/JBJS.19.00591","article-title":"Necrotizing Fasciitis: Pillaging the Acute Phase Response","volume":"102","author":"Hysong","year":"2020","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R2-20240801","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ocl.2016.12.009","article-title":"Double-edged sword: musculoskeletal infection provoked acute phase response in children","volume":"48","author":"Benvenuti","year":"2017","journal-title":"Orthop Clin North Am"},{"issue":"9","key":"R3-20240801","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.2106\/JBJS.RVW.15.00099","article-title":"Pediatric musculoskeletal infection: Hijacking the acute-phase response","volume":"4","author":"An","year":"2016","journal-title":"JBJS Rev"},{"issue":"2","key":"R4-20240801","article-title":"Pediatric Musculoskeletal Infection","volume":"2","author":"Moore-Lotridge","year":"2020","journal-title":"J Pediatric Orthopaedic Society North America"},{"issue":"6","key":"R5-20240801","first-page":"505","article-title":"Neutrophils in the innate immune response","volume":"53","author":"Kobayashi","year":"2005","journal-title":"Arch Immunol Ther Exp (Warsz)"},{"issue":"4","key":"R6-20240801","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s12018-018-9256-x","article-title":"Bone Fracture Acute Phase Response-A Unifying Theory of Fracture Repair: Clinical and Scientific Implications","volume":"16","author":"Baker","year":"2018","journal-title":"Clin Rev Bone Miner Metab"},{"issue":"5","key":"R7-20240801","first-page":"361","article-title":"Rapidly progressive necrotizing fasciitis caused by Staphylococcus aureus","volume":"38","author":"Lee","year":"2005","journal-title":"J Microbiol Immunol Infect"},{"issue":"1","key":"R8-20240801","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0002-9610(99)00259-7","article-title":"Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue infection","volume":"179","author":"Wall","year":"2000","journal-title":"Am J Surg"},{"issue":"3","key":"R9-20240801","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/S1072-7515(00)00318-5","article-title":"A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection","volume":"191","author":"Wall","year":"2000","journal-title":"J Am Coll Surg"},{"issue":"2","key":"R10-20240801","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1177\/000313480206800201","article-title":"Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients","volume":"68","author":"Childers","year":"2002","journal-title":"Am Surg"},{"issue":"8","key":"R11-20240801","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.2106\/00004623-200308000-00005","article-title":"Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality","volume":"85","author":"Wong","year":"2003","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R12-20240801","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jamcollsurg.2008.10.032","article-title":"Necrotizing fasciitis: current concepts and review of the literature","volume":"208","author":"Sarani","year":"2009","journal-title":"J Am Coll Surg"},{"issue":"2","key":"R13-20240801","first-page":"467","article-title":"Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution","volume":"71","author":"Huang","year":"2011","journal-title":"J Trauma"},{"issue":"4","key":"R15-20240801","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3109\/09537104.2014.997690","article-title":"The expanding field of platelet-bacterial interconnections","volume":"26","author":"Kerrigan","year":"2015","journal-title":"Platelets"},{"issue":"1","key":"R16-20240801","doi-asserted-by":"crossref","first-page":"344","DOI":"10.4049\/jimmunol.1601178","article-title":"Platelets mediate host defense against Staphylococcus aureus through direct bactericidal activity and by enhancing macrophage activities","volume":"198","author":"Ali","year":"2017","journal-title":"J Immunol"},{"issue":"2","key":"R17-20240801","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2174\/187152908784533739","article-title":"Beyond hemostasis: the role of platelets in inflammation, malignancy and infection","volume":"8","author":"McNicol","year":"2008","journal-title":"Cardiovasc Hematol Disord Drug Targets"},{"issue":"1","key":"R18-20240801","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1471-2431-8-45","article-title":"Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study","volume":"8","author":"Riise","year":"2008","journal-title":"BMC Pediatr"},{"key":"R19-20240801","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.3389\/fimmu.2019.01687","article-title":"Platelets in sepsis: an update on experimental models and clinical data","volume":"10","author":"Assinger","year":"2019","journal-title":"Front Immunol"},{"issue":"5","key":"R20-20240801","doi-asserted-by":"crossref","first-page":"389","DOI":"10.4065\/mcp.2010.0705","article-title":"Thrombocytopenia in Staphylococcus aureus bacteremia: risk factors and prognostic importance","volume":"86","author":"Gafter-Gvili","year":"2011","journal-title":"Mayo Clin Proc"},{"issue":"1s","key":"R21-20240801","doi-asserted-by":"crossref","first-page":"S99","DOI":"10.1097\/SAP.0000000000003069","article-title":"Prognostic Role of Subsequent Thrombocytopenia in Necrotizing Fasciitis Without Liver Disease","volume":"88","author":"Chen","year":"2022","journal-title":"Ann Plast Surg"},{"key":"R22-20240801","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3389\/fcimb.2017.00159","article-title":"Influence of microbes on neutrophil life and death","volume":"7","author":"Kobayashi","year":"2017","journal-title":"Front Cell Infect Microbiol"},{"issue":"5","key":"R23-20240801","doi-asserted-by":"crossref","first-page":"R192","DOI":"10.1186\/cc9309","article-title":"Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit","volume":"14","author":"de Jager","year":"2010","journal-title":"Crit Care"},{"issue":"SUPP_4","key":"R24-20240801","article-title":"Novel marker for septic hip and knee arthritis: neutrophil-to-lymphocyte ratio is a strong predictor of treatment failure and postoperative 90-day mortality","volume":"101-B","year":"2019","journal-title":"Orthopaedic Proceedings"},{"issue":"1","key":"R25-20240801","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1586\/erc.12.159","article-title":"Neutrophil to lymphocyte ratio and cardiovascular diseases: a review","volume":"11","author":"Bhat","year":"2013","journal-title":"Expert Rev Cardiovasc Ther"},{"issue":"6","key":"R26-20240801","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.amjcard.2008.05.006","article-title":"Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome","volume":"102","author":"Tamhane","year":"2008","journal-title":"Am J Cardiol"},{"issue":"6","key":"R27-20240801","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.amjcard.2007.11.004","article-title":"Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction","volume":"101","author":"N\u00fa\u00f1ez","year":"2008","journal-title":"Am J Cardiol"},{"issue":"6","key":"R28-20240801","doi-asserted-by":"crossref","first-page":"dju124","DOI":"10.1093\/jnci\/dju124","article-title":"Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis","volume":"106","author":"Templeton","year":"2014","journal-title":"J Natl Cancer Inst"},{"issue":"1","key":"R29-20240801","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1245\/s10434-011-1814-0","article-title":"Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients","volume":"19","author":"Azab","year":"2012","journal-title":"Ann Surg Oncol"},{"issue":"4","key":"R30-20240801","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1038\/bjc.2012.292","article-title":"A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer","volume":"107","author":"Proctor","year":"2012","journal-title":"Br J Cancer"},{"issue":"3","key":"R31-20240801","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s15010-016-0972-1","article-title":"Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever","volume":"45","author":"Naess","year":"2017","journal-title":"Infection"},{"issue":"3","key":"R32-20240801","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1002\/jcla.21669","article-title":"Association of neutrophil to lymphocyte ratio with presence and severity of gastritis due to Helicobacter pylori infection","volume":"28","author":"Farah","year":"2014","journal-title":"J Clin Lab Anal"},{"issue":"1","key":"R33-20240801","doi-asserted-by":"crossref","first-page":"6981","DOI":"10.4081\/hr.2017.6981","article-title":"Can Ratio of Neutrophil-to-Lymphocyte Count and Erythrocyte Sedimentation Rate in Diabetic Foot Infecti on Predict Osteomyelitis and\/or Amputation?","volume":"9","author":"Yap\u0131c\u0131","year":"2017","journal-title":"Hematol Rep"},{"issue":"2","key":"R34-20240801","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1089\/sur.2015.126","article-title":"Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Are More Effective than the Fournier\u2019s Gangrene Severity Index for Predicting Poor Prognosis in Fournier\u2019s Gangrene","volume":"17","author":"Yim","year":"2016","journal-title":"Surg Infect (Larchmt)."},{"issue":"3","key":"R35-20240801","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s12262-019-01929-w","article-title":"Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Versus Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) as Predictors of Outcome in Necrotising Fasciitis","volume":"82","author":"Ravindhran","year":"2020","journal-title":"Indian J Surgery"},{"issue":"7","key":"R36-20240801","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1097\/01.CCM.0000129486.35458.7D","article-title":"The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections","volume":"32","author":"Wong","year":"2004","journal-title":"Crit Care Med"},{"issue":"5","key":"R37-20240801","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1308\/rcsann.2017.0053","article-title":"Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature","volume":"99","author":"Bechar","year":"2017","journal-title":"Ann R Coll Surg Engl"},{"issue":"1","key":"R38-20240801","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.1097\/BPO.0000000000001256","article-title":"C-Reactive Protein Predicts Risk of Venous Thromboembolism in Pediatric Musculoskeletal Infection","volume":"39","author":"Amaro","year":"2019","journal-title":"J Pediatr Orthop"},{"issue":"7","key":"R39-20240801","doi-asserted-by":"crossref","first-page":"e0132775","DOI":"10.1371\/journal.pone.0132775","article-title":"Improvement of a Clinical Score for Necrotizing Fasciitis: \u2018Pain Out of Proportion\u2019 and High CRP Levels Aid the Diagnosis","volume":"10","author":"Borschitz","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"R40-20240801","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13049-017-0359-z","article-title":"The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role","volume":"25","author":"El-Menyar","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"R41-20240801","article-title":"Missing data in orthopaedic research","volume":"19","author":"Baldwin","year":"2009","journal-title":"U Pennsylvania Orthopaedic Journal"},{"issue":"10","key":"R42-20240801","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1002\/jmv.25819","article-title":"Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis","volume":"92","author":"Lagunas-Rangel","year":"2020","journal-title":"J Med Virol"},{"issue":"1","key":"R43-20240801","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1186\/s13054-020-03374-8","article-title":"Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis","volume":"24","author":"Li","year":"2020","journal-title":"Crit Care"},{"key":"R44-20240801","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.thromres.2020.05.006","article-title":"The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China","volume":"192","author":"Fu","year":"2020","journal-title":"Thromb Res"},{"key":"R45-20240801","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ajem.2021.01.006","article-title":"Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis","volume":"42","author":"Simadibrata","year":"2021","journal-title":"Am J Emerg Med"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.22.00106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:37:48Z","timestamp":1787751468000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.22.00106"}},"subtitle":["A Retrospective Study"],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.22.00106","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}