Albumin-to-globulin ratio and neutrophil percentage as predictive markers for necrotizing fasciitis prognosis.

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with high mortality and morbidity. Early prognostic assessment is crucial for improving clinical outcomes. This retrospective study aimed to identify and evaluate potential plasma biomarkers for NF poor prognosis. Data from 109 NF patients admitted between 2015 and 2025 were analyzed, with 78 in the favorable prognosis group (recovery) and 31 in the adverse group (amputation or death). Laboratory markers, including inflammatory, coagulation, and metabolic parameters, were assessed within 24 h of admission. Multivariate logistic regression identified albumin-to-globulin ratio (AGR) as an independent protective factor (OR = 0.028, 95 % CI: 0.002-0.373, p = 0.007), and both diabetes history and neutrophil percentage (NEUT%) as risk factors (OR = 4.387, 95 % CI: 1.234-15.601, p = 0.022; OR = 1.103, 95 % CI: 1.008-1.207, p = 0.033, respectively). The activated partial thromboplastin time (APTT) showed only borderline significance. ROC analysis revealed AGR had the highest predictive value (AUC = 0.803, cutoff = 1.205), followed by NEUT% (AUC = 0.733, cutoff = 31.450). The study highlights AGR and NEUT% as promising biomarkers for NF prognosis, reflecting the interplay of inflammation, nutrition, metabolism, and coagulation. These findings advocate for integrating multi-dimensional markers to enhance early risk stratification and guide targeted interventions. Limitations include the single-center retrospective design and limitations of the dataset; future multicenter studies are needed for validation.