DOI: http://dx.doi.org/10.18203/2349-2902.isj20185041

Use of serum lactate and serum sodium at admission to predict mortality in necrotising fasciitis

Sudhir S., Rachit Arora

Abstract


Background: The term necrotizing fasciitis (NF) describes a group of life-threatening infections of the skin, soft tissues, and muscles, which tend to progress rapidly through the fascia planes, causing gradual destruction of the fascia. The mortality rate for NF remains high and has not changed significantly for several decades. The prognosis depends on accurate diagnosis and immediate institution of appropriate treatment.

The current difficulty in initial diagnosis is due to the lack of obvious skin findings early on in the infection. Laboratory tests, including the laboratory risk indicator for necrotizing fasciitis, gas on imaging tests, and physical exam findings.

Methods: This is a prospective study of 100 patients of necrotising fasciitis. Serum sodium and serum lactate at time of admission were used to predict mortality.

Results: Total of 21 patients died. Above Serum lactate value of 2.95mmol/l mortality rate was 48.3%. and below it was 9.9%. Serum sodium was non significant in predicting mortality.

Conclusions: The mortality of NF remains high. A simple model using serum lactate at time of admission may help identify patients at greatest risk of death.

 


Keywords


Lactate, Necrotising fasciitis, Sodium

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References


Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Frontiers Surg. 2014 Sep 29;1:36.

Wall DB, Klein SR, Black S, De Virgilio C. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection1. J Am Coll Surgeons. 2000 Sep 1;191(3):227-31.

Levraut J, Ichai C, Petit I, Ciebiera JP, Perus O, Grimaud D. Low exogenous lactate clearance as an early predictor of mortality in normolactatemic critically ill septic patients. Critical Care Med. 2003 Mar 1;31(3):705-10.

Roumen RM, Redl H, Schlag G, Sandtner W, Koller W, Goris RJ. Scoring systems and blood lactate concentrations in relation to the development of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients. J Trauma. 1993 Sep;35(3):349-55.

Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, Bennett ED. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med. 2001 Jan 1;27(1):74-83.

Yaghoubian A, de Virgilio C, Dauphine C, Lewis RJ, Lin M. Use of admission serum lactate and sodium levels to predict mortality in necrotizing soft-tissue infections. Archi Surgery. 2007 Sep 1;142(9):840-6.

Çolak E, Ozlem N, Kucuk GO, Aktimur R, Kesmer S. Laboratory risk indicators for necrotizing fasciitis and associations with mortality. Turkish J Emergency Med. 2014 Mar 1;14(1):15-9.

Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, et al. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emergency Surg. 2016 Dec;11(1):40.

Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Anna Surg. 1996 Nov;224(5):672.

Martinschek A, Evers B, Lampl L, Gerngroß H, Schmidt R, Sparwasser C. Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier’s gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients. Urologia Int. 2012;89(2):173-9.

Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Frontiers Surg. 2014 Sep 29;1:36.