The Charlson comorbidity index may serve as a good predictor of intensive care unit mortality in patients with necrotizing fasciitis

The Charlson Comorbidity Index (CCI) is a well-established predictor of mortality across various clinical conditions, but its prognostic value in patients admitted to the intensive care unit (ICU) for necrotizing fasciitis (NF) remains unclear. This study aimed to evaluate the prognostic value of the CCI for ICU and in-hospital mortality in patients with NF. This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version 2.2) database from 2008 to 2019. NF was identified using ICD-9 and ICD-10 codes 728.86 and M72.6, respectively. Cox proportional hazards models were used to assess the associations of the CCI and other clinical variables with ICU and in-hospital mortality. Among 139 adult patients admitted to the ICU for NF, the ICU mortality rate was 11.51%, and the mean CCI was 4.81 ± 2.86. Receiver operating characteristic curve analysis identified CCI > 5 as the optimal cutoff for predicting ICU and in-hospital mortality. At this cutoff, sensitivity and specificity were 81.3% and 65.9% for ICU mortality and 78.3% and 68.1% for in-hospital mortality, respectively. Multivariable analysis showed that the CCI remained independently associated with both mortality outcomes. A CCI > 5 was associated with adjusted hazard ratios of 8.089 (95% CI 1.507–43.402, P = .02) for ICU mortality and 5.993 (95% CI 1.737–20.669, P = .005) for in-hospital mortality. The CCI is a reliable predictor of both ICU and in-hospital mortality in patients with NF.