Mortality risk factors among patients with necrotizing fasciitis: a systematic review and meta-analysis of cohort studies

To identify key risk factors associated with mortality in necrotizing fasciitis (NF) and provide clinicians with evidence-based guidance for risk stratification and management. A systematic review and meta-analysis was conducted. PubMed, Embase, Web of Science, Cochrane Library, and ProQuest were searched from inception to 19 May 2023, with an update on 31 May 2025. Cohort studies reporting adjusted risk estimates for NF-related mortality were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Of 30,563 identified articles, 14 studies involving 26,242 patients were included. The strongest predictors of NF mortality were advanced age (odds ratio [OR] 1.160, 95% CI 1.100–1.223), cardiopathy (OR 2.210, 95% CI 1.274–3.833), elevated creatinine (OR 2.200, 95% CI 1.127–4.294), and Clostridium infection (OR 6.422, 95% CI 2.171–19.003). Race appeared protective, particularly among Black patients (OR 0.780, 95% CI 0.645–0.943). No significant associations were found for gender, pneumopathy, hepatopathy, nephropathy, diabetes, malignancy, or several laboratory and microbial factors. Advanced age, cardiopathy, elevated creatinine, and Clostridium infection are significant mortality risk factors in NF. Race may have a protective effect. Further research is warranted to clarify the roles of other clinical and laboratory variables.