Hyperlactatemia is one of the most frequently encountered metabolic alterations in the critically ill patient, and is associated with an unfortunate outcome. In this study, Cheng et al. aim to establish whether hyperlactatemia on arrival at the Emergency Department is a reliable predictor for in-hospital mortality in patients suffering from necrotizing fasciitis.

Cheng et al. conducted a prospective cohort study of patients admitted to hospital with necrotizing fasciitis in two tertiary teaching hospitals in Taiwan between March 2010 and March 2018. A blood sample was collected in the first hour upon patient arrival to the Emergency Department in order to determine the blood lactate level.

SOFA (Sequential organ failure assessment: one of the scoring systems used for assessing the severity of disease in critically ill patients and predicting their outcome) scores were calculated during the first 24 h after admission. All collected data were statistically analysed.

The results of this investigation showed that of the total of 707 necrotizing fasciitis patients included in the study, 40 (5.66%) died in the hospital. The blood lactate concentration on arrival at the Emergency Department in non-survivors was remarkably higher than in survivors (P < 0.001). SOFA scores in non-survivors were also significantly higher than in survivors.

The results showed that the blood lactate level was a predictor of in-hospital mortality in necrotizing fasciitis patients. Cheng et al. indicate that patients with high blood lactate levels at the Emergency Department should be carefully observed for signs of clinical deterioration.

This article was written by Chia-Peng Chang , Wen-Chih Fann, Shu-Ruei Wu, Chun-Nan Lin and Cheng-Ting Hsiao, and it was published in 2019 by Journal of Orthopaedic Surgery and Research [(2019) 14:73]

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