ORAL PRESENTATIONS – STUDENTS
BEYOND TRADITIONAL RISK FACTORS IN NECROTIZING FASCIITIS MORTALITY - ANALYSIS OF 40,254 CASES CHALLENGES COMMON ASSUMPTIONS Dara Bruce, Abdallah Attia, Ahmed Abdelmaksoud, Eman Toraih; Tulane University School of Medicine, New Orleans, LA.
Introduction: Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection with significant mortality, yet large-scale analyses of mortality risk factors remain limited. Understanding these factors is crucial for early intervention and improved patient outcomes. Methods/Results: We conducted a retrospective analysis of 40,254 NF cases from TriNetX database, obtained by ICD-10 code, over 20 years from 2004- 2024. We examined the association between mortality within 90 days and multiple variables including demographics, comorbidities, and clinical factors. Relative risks (RR) with 95% confidence intervals were calculated for each variable, with statistical significance set at p<0.05. Overall mortality was 11.8% (4,755/40,254). Demographic analysis revealed higher risk in females (RR=4.19), and older patients (non-survivors 68.0±14.6 vs survivors 59.4±15.2 years). Black/African American patients showed lower mortality risk compared to White patients (RR=0.89), while Asian patients showed higher risk (RR=1.20). The strongest 90-day mortality predictors were disseminated intravascular
coagulation (RR=6.57, 95% CI: 5.76-7.51), hepatic failure (RR=3.98, CI: 3.69-4.29), and coagulation disorders (RR=2.35, CI: 2.21-2.49). Following NF diagnosis, diagnosis of respiratory failure (RR=2.03), Acute Respiratory Distress Syndrome (RR=2.19), acute kidney injury (RR=1.48), and cardiovascular complications, particularly atrial fibrillation (RR=1.98), significantly impacted survival within 90 days. Antimicrobial resistance diagnosis increased mortality risk (RR=1.29, CI: 1.19-1.41). Notably, malnutrition (RR=1.62), and underweight status (BMI<19.9, RR=1.16) were found to increase risk of death. Our findings indicated type 1 Diabetes patients had lower risk of mortality (RR=0.83), while Type 2 diabetes patients did not show significant risk (p=0.07). Discussion: This large-scale analysis identifies critical risk factors and predictors of NF mortality, highlighting the importance of coagulation disorders, organ failure, metabolic derangements, and demographic factors. These findings suggest the need for targeted surveillance of high- risk patients and may inform the development of risk-stratified management protocols.
WHEN ANATOMY MEETS PATHOLOGY: THE ROLE OF MAY- THURNER SYNDROME IN YOUNG ISCHEMIC STROKE Christine Robbie, Yasmeen Nabhani, Evan Multala, Max Tran, Robert Miller; Tulane University School of Medicine, New Orleans, LA.
Introduction: May-Thurner Syndrome is an anatomical variant present in approximately 20% of the population, characterized by the compression of the left common iliac vein against the spine by the overlying right common iliac artery. This often underdiagnosed condition is a significant underlying cause of deep vein thrombosis (DVT) and should be considered in the differential diagnosis of non- atherosclerotic ischemic stroke in younger patients.
Case: A 26-year-old female with migraine headaches, presented with right sided weakness, numbness, and speech deficits. She was stroke-activated in the emergency room and a MRI of the brain revealed a 3mm focus of acute ischemia in the left parietal lobe. Her symptoms resolved completely within a couple of hours, and although she remained within the time frame for tenecteplase (tPA) administration, the patient declined it after a conversation about risks and benefits. An extensive work up for a stroke 63
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