Lactate on emergency department arrival as a predictor of in-hospital mortality in necrotizing fasciitis: a retrospective study

Abstract

Background Hyperlactatemia is known to be associated with adverse outcome in critical illness. In this study, we attempted to identify if hyperlactatemia on emergency department (ED) arrival is a reliable predictor for in-hospital mortality in necrotizing fasciitis (NF) patients. Method A prospective cohort study of hospitalized patients with NF was conducted in two tertiary teaching hospitals in Taiwan between March 2010 and March 2018. Blood samples were collected in the ED upon arrival, and the lactate levels were determined. Sequential organ failure assessment (SOFA) scores were calculated during the first 24 h after admission. All collected data were statistically analyzed. Result Of the 707 NF patients, 40 (5.66%) died in the hospital. The median (interquartile range) blood lactate level in all NF patients was 3.6 mmol/l (2.2–4.8). The blood lactate level upon ED arrival was significantly associated with mortality (odds ratio [OR] = 1.35; 95% confidence interval [CI], 1.30–1.46; P < 0.001), even after adjustment for age and SOFA score (OR = 1.27; P < 0.001). Multivariate regression analysis showed that a high blood lactate level (OR = 1.17; 95% CI, 1.07–1.29; P = 0.001) and a high SOFA score (OR = 1.15; 95% CI, 1.11–1.20; P < 0.001) were independent risk factors for in-hospital mortality in NF. Blood lactate achieved an area under-the-receiver-operating-characteristic curve (AUC) of 0.79 ( P < 0.001) for predicting mortality that was similar to that of SOFA score (AUC = 0.82; P < 0.001). Blood lactate displayed a sensitivity of 62% and a specificity of 86% in predicting mortality at the optimal cutoff value of 5.80 mmol/l. Conclusion In necrotizing fasciitis patients, hyperlactatemia on ED arrival is independently associated with in-hospital mortality. NF patients with hyperlactatemia on ED arrival should be closely monitored for signs of deterioration and consider early and aggressive intervention to prevent mortality.

Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan

“…Thus, the LRINEC scoring system is not applicable for determining the early management of patients with suspected Vibrio and Aeromonas NF [19], as well as in this study. In patients with NF, hyperlactatemia is independently associated with in-hospital mortality [37]. Hyperlactatemia generally occurs in patients with shock, respiratory failure, or renal failure [38], consistent with our study.…”

Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections

“…Firstly, we added liver disease, which was significantly more prevalent in patients with NF than in patients without NF and it was also independently associated with NF. Besides, we added serum lactate level, which was confirmed to be associated with critical conditions and NF mortality [23]. Second, we redefined the cut-off values for CRP, total WBC count, and hemoglobin level to be 30 mg/dL, 15 × 10 4 /uL, and 11 g/dL, respectively.…”

Prognostic factors for mortality in 123 severe cases of necrotizing fasciitis in 5 hospitals in the Netherlands between 2003 and 2017

“…Our data supported these findings. A cut-off point of 1.7 mmol/L was chosen based on daily practise (33.7% vs 8.7%, p = 0.036) [25,26]. However, our data did not implicate a higher mortality in patients with a white blood cell count greater than This could be explained by the small amount of patients (groups of 3 and 5 patients) with a white blood cell count greater than 30.000 × 10^3 µL.…”