PREDICTORS OF EARLY RE-NECROSECTOMY IN DIABETIC PATIENTS WITH NECROTIZING SOFT TISSUE INFECTIONS

Necrotizing soft tissue infections in patients with diabetes mellitus are characterized by an aggressive clinical course and a high rate of repeat surgical intervention. Objective of the study. To identify predictors of early re-necrosectomy and assess their prognostic value. Materials and methods. This single-centre cohort study enrolled 128 patients with necrotizing soft tissue infections and concurrent diabetes mellitus treated between 2016 and 2025, with re-necrosectomy within 72 hours defined as the primary endpoint. The study was conducted in accordance with the Declaration of Helsinki and applicable national regulations governing biomedical research involving human subjects. The study protocol received approval from the institutional review board of the treating facility. Prior to enrolment, all participants provided written informed consent for the use of de-identified clinical and laboratory data for research purposes. Statistical analysis was carried out with IBM SPSS Statistics 26.0 and MedCalc 20.0. The study was conducted at Bukhara State Medical Institute under the institutional research programme entitled "Early Detection, Diagnosis, and Novel Treatment and Prevention Strategies for Pathological Factors Affecting Population Health in the Bukhara Region During the Post-COVID-19 Pandemic Period (2022–2026)." Results. Re-necrosectomy within the early postoperative period was carried out in 89 patients (69.5%); this group more frequently had a prolonged history of diabetes mellitus, higher HbA1c levels and admission glycaemia, and a more pronounced systemic inflammatory response. The most substantial intergroup differences were identified through analysis of local cytological and microbiological parameters: patients who required early re-necrosectomy demonstrated a significant elevation in the neutrophil destruction index, tissue destruction index, and microbial-cellular index. This group also exhibited greater microbial mass density, a higher proportion of polymicrobial associations, and a predominance of Gram-negative flora, reflecting a more aggressive infectious process and indicating the need for broader surgical debridement. Conclusions. Comprehensive assessment of local cytological and microbiological parameters in conjunction with lactate levels enables prediction of the need for re-necrosectomy within the first 72 hours.

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