Prognosis
The prognosis for gangrene is highly variable, reflecting the spectrum of types and severity that may be encountered clinically. Even though outcomes have improved generally, it remains a potentially life- and limb-threatening condition. The two key factors in improving outcomes are early recognition and aggressive antibiotic and surgical management.
Before the availability of antibiotics, gas gangrene was usually fatal. However, with aggressive antibiotic therapy and aggressive surgical therapy this is no longer the case.
Mortality from necrotizing fasciitis properly treated with surgery plus antibiotics has been estimated at between 10% and 40%.[5] Mortality is higher in patients who develop shock and end-organ damage, approaching 30% to 70%.[16] Recurrence of necrotizing fasciitis is rare.[77] However, significant functional and cosmetic morbidity may remain following initial surgical therapies, which may require subsequent reconstruction. Predictors of morbidity and mortality include WBC >30,000/microliter, serum creatinine >2.0 mg/dL (>177 micromol/L), clostridial infection, presence of heart disease on admission, cirrhosis of the liver, soft-tissue air, Aeromonas infection, age >60 years, band neutrophils >10%, activated PTT >60 seconds, streptococcal toxic shock syndrome, delay in surgery >12 hours, and bacteremia. Length of time from admission to surgery has had mixed results in terms of impact on mortality.[78][79]
In patients with critical leg ischemia, 50% to 60% will undergo some form of surgical or endovascular procedure (although in some specialist units the figure may be nearer 90%). Primary amputation rates range from 10% to 40%. Mortality rate in these patients with standard therapy is around 20% at 1 year, and between 40% and 70% at 5 years. However, 95% of patients who present with ischemic gangrene, and 80% of those presenting with rest pain, are dead within 10 years.[80]
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