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

BackgroundHyperlactatemia 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.MethodA 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 24h after admission. All collected data were statistically analyzed.ResultOf the 707 NF patients, 40 (5.66%) died in the hospital. The median (interquartile range) blood lactate level in all NF patients was 3.6mmol/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 5.80mmol/l.ConclusionIn 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.