SRS251 - Necrotizing fasciitis outcomes in diabetic <i>versus</i> non-diabetic patients: a systematic review and meta-analysis

Abstract Background Necrotising fasciitis (NF) is a rapidly progressive, life-threatening infection, a common site being the lower limbs. Diabetes mellitus (DM) is a key risk factor influencing the progression, outcome, and management of NF. Despite its clinical relevance, comparative data on diabetic versus non-diabetic NF outcomes remain limited. Objectives Compare mortality, amputation rates, and key outcomes between diabetic and non-diabetic patients with NF. Methods A systematic review and meta-analysis were conducted following the PRISMA guidelines. Eligible studies assessed outcomes in diabetic and non-diabetic NF patients. Primary outcome measures were amputation rates, mortality, length of hospital stay, debridement frequency, and microbial growth. Secondary outcomes included the 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. Results Nine studies comprising 1890 patients met the inclusion criteria. Diabetic patients had significantly higher rates of amputation (OR 3.77, 95% c.i.:3.04–4.68, P &amp;lt; 0.001) and polymicrobial infections (OR 2.48, 95% c.i.:1.48–4.16; P &amp;lt; 0.001). Mortality was higher among patients with diabetes after sensitivity analysis (OR 1.60, 95% c.i.:1.09–2.24, P = 0.015). No significant differences were observed in the number of debridements or length of admission. Diabetic patients had higher LRINEC scores (MD 2.02, 95% c.i.:1.33–2.72; P &amp;lt; 0.001). Conclusions Diabetic patients with NF experience worse clinical outcomes, including increased risk of amputation rates, mortality, and polymicrobial infections. This meta-analysis underscores the need for prompt, aggressive intervention and risk stratification in DM populations. Further, high-quality prospective studies are required to strengthen the evidence base.