title: Use of admission serum lactate and sodium levels to predict mortality in necrotizing soft-tissue infections.
abstract: OBJECTIVE
  Simple admission laboratory values can be used to classify patients with necrotizing soft-tissue infection (NSTI) into high and low mortality risk groups.
  
  
  METHODS
  Chart review.
  
  
  METHODS
  Public teaching hospital.
  
  
  METHODS
  All patients with NSTI from 1997 through 2006.
  
  
  METHODS
  Variables analyzed included medical history, admission vital signs, laboratory values, and microbiologic findings. Data analyses included univariate and classification and regression tree analyses.
  
  
  METHODS
  Mortality.
  
  
  RESULTS
  One hundred twenty-four patients were identified with NSTI. The overall mortality rate was 21 of 124 (17%). On univariate analysis, factors associated with mortality included a history of cancer (P = .03), intravenous drug abuse (P < .001), low systolic blood pressure on admission (P = .03), base deficit (P = .009), and elevated white blood cell count (P = .06). On exploratory classification and regression tree analysis, admission serum lactate and sodium levels were predictors of mortality, with a sensitivity of 100%, specificity of 28%, positive predictive value of 23%, and negative predictive value of 100%. A serum lactate level greater than or equal to 54.1 mg/dL (6 mmol/L) alone was associated with a 32% mortality, whereas a serum sodium level greater than or equal to 135 mEq/L combined with a lactate level less than 54.1 mg/dL was associated with a mortality of 0%.
  
  
  CONCLUSIONS
  Mortality for NSTIs remains high. A simple model, using admission serum lactate and serum sodium levels, may help identify patients at greatest risk for death.
authors: Department of Surgery, Los Angeles Biomedical Research Institute, CA, USA.
authors: Arezou
authors: A
authors: Yaghoubian
authors: Christian
authors: C
authors: de Virgilio
authors: Christine
authors: C
authors: Dauphine
authors: Roger J
authors: RJ
authors: Lewis
authors: Matthew
authors: M
authors: Lin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D009336:Necrosis; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012964:Sodium / Q000097:blood*; D018461:Soft Tissue Infections / Q000097:blood* / Q000382:microbiology / Q000401:mortality*
chemical_list: D007773:Lactates; D012964:Sodium