Tracking a Fatal Disease: Lower Limb Gas Gangrene's Mortality-Related Factors

Abstract

Because of its rarity compared to dry and wet gangrene of the lower limb, the gaseous form has often been considered as the most severe form of gangrenous disease. We aimed to report clinical, paraclinical, and therapeutic features, and to identify mortality risk factors of gas gangrene of the lower limb. We conducted a one-center case series retrospective study over a period of 13 years from January 2006 to December 2018. A total of 19 patients were included: 12 men, 7 women. Mean age was 59.3  ±  11.3 years. There were 17 diabetic patients and one patient was on radio-chemotherapy for lower rectal cancer. Septic shock was initially present in 4 cases. Hyperleukocytosis was noted in 17 patients. C-reactive protein was elevated in 11 patients. All patients were put on antibiotics then operated on. A total of 8 patients died postoperatively (42%) in an average time of 9.6 days after surgery. On univariate analysis, factors associated with mortality were: Septic shock on admission (p  =  0.02); local signs limited to foot (p  =  0.05) or extended above the knee (p  =  0.02); leukocytosis (p  =  0.005); glycemia level (p  =  0.02); antibiotic therapy duration (p  =  0.04); antibiotic association of Penicillin G, metronidazole, and gentamicin (p  =  0.02); amputation procedure solely (p  =  0.04) or debridement procedure without amputation (p  =  0.05); intraoperative transfusion (p  =  0.006); and hospital stay (p  =  0.01). Identifying gas gangrene mortality factors is fundamental to standardize management. Our study was able to build on the small size of our series, but further prospective and large-scale studies are required.