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J Korean Soc Emerg Med > Volume 24(5); 2013 > Article
Journal of The Korean Society of Emergency Medicine 2013;24(5): 525-532.
Predictors of Mortality in Patients Treated in an Emergency Department for Necrotizing Fasciitis
Sung Mo Ku, Hyun Kim, Yong Sung Cha, Oh Hyun Kim, Kyoung Chul Cha, Kang Hyun Lee, Sung Oh Hwang
Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea. khyun@yonsei.ac.kr
Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED.
A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed.
Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777).
Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
Key words: Necrotizing fasciitis, Necrotizing soft tissue infections
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