Clinical Value of the C-Reactive Protein-To-Albumin Ratio and Neutrophil-To-Lymphocyte Ratio in Diagnosing and Predicting the Prognosis of Limb Necrotizing Fasciitis.

INTRODUCTION

Limb necrotizing fasciitis (limb NF) is a severe soft tissue infection where early diagnosis is critical but often hindered by non-specific manifestations. This study investigates the diagnostic utility and prognostic assessment ability of the C-reactive protein-to-albumin ratio (CAR) and the neutrophil-to-lymphocyte ratio (NLR) for limb NF diagnosis and prognostic stratification.

METHODS

In this retrospective study, 145 patients with limb soft-tissue infections were categorized into limb NF (n = 61) and non-NF (n = 84) groups. Poor prognosis (n = 28) was defined as in-hospital death, amputation, or sepsis. Laboratory parameters from admission were compared. Multivariable logistic regression and ROC analyses were employed.

RESULTS

Demographics were comparable between groups. CAR and NLR levels were significantly elevated in the limb NF cohort (P < 0.05). Both were independent diagnostic biomarkers (CAR: OR = 1.46, AUC = 0.90; NLR: OR = 1.07, AUC = 0.85) and independent predictors of poor prognosis (CAR: OR = 1.43, AUC = 0.90; NLR: OR = 1.03, AUC = 0.79). A combined CAR-NLR model demonstrated superior accuracy for diagnosis (AUC = 0.91) and prognosis (AUC = 0.92).

CONCLUSIONS

CAR and NLR are independent biomarkers for the diagnosis and risk stratification of limb NF. Combined use enhances discriminatory accuracy and may support earlier identification and prognostic assessment to inform clinical management.