Exploring Outcomes of Necrotising Fasciitis in Diabetic vs Non-Diabetic Patients: A Systematic Review and Meta-Analysis

Abstract

Aim: Necrotising fasciitis (NF) is a life-threatening soft tissue infection with significant morbidity and mortality. Diabetes mellitus is a key risk factor influencing the progression, outcome, and management of NF. Despite its importance, literature exploring the disparities between diabetic and non-diabetic NF patients remains limited. Perform a systematic review and meta-analysis comparing outcomes of NF in diabetic versus non-diabetic patients. Method(s): A systematic review and meta-analysis were conducted following PRISMA guidelines. A search of the CENTRAL and PubMed identified all studies reporting outcomes in both cohorts. Nine studies involving over 1,200 patients were included. Primary outcome measures were amputation rates, mortality, admission length, debridement frequency, and microbial growth. Secondary outcomes included LRINEC scores, BMI, and renal disease. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using OpenMeta[Analyst] software. Heterogeneity was assessed via Cochran's Q test and I statistics. The Newcastle-Ottawa Scale evaluated study quality and bias risk. Result(s): Diabetic patients had significantly higher amputation rates (OR 3.790, 95% CI:3.053-4.705; p<0.001) and incidence of polymicrobial infections (OR 2.475, 95% CI:1.475-4.155; p<0.001). Diabetics displayed higher mortality after sensitivity analysis (p=0.011). No significant differences were observed in admission duration or debridement frequency. Diabetic patients had significantly higher LRINEC scores (MD 2.024, 95% CI:1.332-2.716; p<0.001). Conclusion(s): Diabetic NF patients experience worse outcomes, including higher amputation rates, mortality, and more severe infections. This meta-analysis underscores the need for early intervention, tailored management, and standardisation of diagnosis to improve outcomes in diabetic NF populations. Further high-quality prospective studies are warranted. 1 2 .