Objective: Necrotizing fasciitis (NF) is a surgical diagnosis with friability of the superficial fascia. Gout is a disease of purine or uric acid metabolism. Gout patients complicated with NF were associated with high morbidity and mortality. We aimed to evaluate the characteristics and outcomes of patients with NF accompanied with or without gout in Eastern Taiwan.

Material and Methods: We performed a retrospective review of patients with a diagnosis of NF admitted to Hualien Tzu Chi Hospital between January 2017 and December 2020. Primary outcomes were the correlation between multiple characteristics and outcomes in patients with NF being with or without gout. Secondary outcome were presentations in gout patients between medication-controlled group and non-medication-controlled group and analysis for predictors associated with be amputated or not.

Results: Total 251 patients diagnosed with NF were included and were categorized as being with gout (n=38) or not (n=213). Patients with gout had a higher percentage of man (81.6% vs 62.9%; p=0.026) and were associated with higher rate of alcoholism (28.9% vs 8%, p=0.01) and higher percentage of steroid use. (23.7% vs 8.9%, p=0.021). Patients without gout had a higher percentage of DM (71.8% vs 28.9%; p=<0.001), PAOD (31.5% vs 5.3%; p=0.001) and higher Charlson Comorbidity Index (CCI) (3 vs 4; p=0.029). There were no statistical significance in pre-operative evaluation, clinical presentations, surgical outcomes or in-hospital mortality. There was no statistically significant amputation rate between two groups. But patients with gout had higher percentage of minor amputation than major amputation (83.3% vs 16.7%). In patients undergone amputation, the indication of amputation in patients with gout had higher percentage of joint instability instead of ischemic change; on the contrary, patients without gout had higher percentage of ischemic change instead of joint instability (p=0.004). For secondary outcome, gout patients with or without medication control had no statistically significance in serum uric acid level, clinical presentations, surgical outcomes or in-hospital mortality. Under multivariant logistic regression analysis, DM and PAOD were statistically associated with being amputated. (DM/PAOD: OR=3.75/2.77; 95% CI: 1.14-12.31/1.12-6.82; p=0.03/0.027); obesity was inversely associated with being amputated (OR=0.31; 95% CI: 0.12-0.82; p=0.018). And gout was not one of the predictors of being amputated. (OR=1.78; 95% CI: 0.54-5.91); p=0.347)
Conclusions: In our study, gout complicated with necrotizing fasciitis was not associated with higher mortality rate or amputation rate, which was inconsistent with previous studies. And in gout patients, those with medication control were not associated with better outcome.

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