Model for End‐Stage Liver Disease Is a Novel Potential Predictor of 30‐Day Mortality in Patients With Necrotizing Fasciitis

ABSTRACT Background Necrotizing fasciitis (NF) is a rapidly progressive soft‐tissue infection with high morbidity and mortality. Early identification of patients at risk for ICU admission and 30‐day mortality is critical. Methods In this multicenter cohort study, 88 NF patients were compared with age‐ and gender‐matched erysipelas controls. We studied systemic immune‐inflammation biomarkers (e.g., SII, NLR), the model for end‐stage liver disease (MELD; calculated from serum bilirubin, creatinine, and INR), kidney markers, and the LRINEC score at presentation. Logistic regression identified ICU admission predictors; Cox regression assessed 30‐day mortality. Results Compared with erysipelas controls, NF patients had higher white‐cell counts, liver enzymes, creatinine, CRP, and procalcitonin; only MELD differed among composite indices ( p < 0.01). Of 88 NF cases, 58 (65.9%) required ICU care and 21 (23.9%) died within 30 days. Univariable analysis linked ICU admission to CRP > 295.3 mg/L, sepsis, trunk involvement, no upper‐extremity infection, and higher LRINEC (all p < 0.01). Thirty‐day mortality correlated with younger age, dementia, severe liver disease, eosinopenia, and elevated MELD, INR, and creatinine (all p < 0.05). Multivariable models showed CRP > 295.3 mg/L (OR 42.5; 95% CI 4.3–424.4) and sepsis (OR 13.5; 95% CI 3.3–32.8) as independent ICU admission predictors, and MELD score alone predicted 30‐day mortality (HR 1.61 per point; 95% CI 1.13–2.30). Conclusions High CRP levels confirm their value in predicting ICU admission; however, the most novel finding is the independent prognostic power of MELD for 30‐day mortality. Incorporating MELD alongside CRP into clinical pathways could markedly improve early risk stratification.