The mean value ( SD) of serum lactate at admission to the ICU was 4.22 5.42 mmol/l, the median SOFA score and SAPS II were 7 (IQR 4 – 10) and 46 (IQR 30.5 – 53). 42 (71%) and 38 patients (64%). The mean value ( SD) of serum lactate at admission to the ICU was 4.22 5.42 mmol/l, the median SOFA score and SAPS II were 7 (IQR 4 – 10) and 46 (IQR 30.5 – 53). ICU mortality rate was 25%. Both SOFA score and serum lactate exhibited a good prognostic value regarding ICU end result (OR 1.29, 95%CI 1.07-1.57, 0.007 and OR 1.53, 95%CI 1.19-1.98, 0.001). A cut-off value for serum lactate of 6.55 mmol/L positively predicted mortality with 67% sensitivity and 97% specificity. Conclusion: NSTIs carry a high risk of septic shock and multiple organ dysfunction syndrome and thus are still associated with high mortality. In our study, the value of serum lactate at admission to Asenapine the ICU correlated well with mortality. This easy-to-measure parameter could play a role in the decision-making process regarding prognosis and continuation of care. valuevaluevaluevalueor was an independent factor for increased mortality. 21 In a recently published study, contamination with Streptococcus pyogenes of Group A was associated with a significantly lower mortality. 25 Both and were the most frequent microorganisms in a large study from Thailand, but there was no correlation to the outcome. 20 NSTIs with appear sporadically in the form of case reports. 26,27 The 2 2 bacteria typically appeared in type I (polymicrobial) NSTI, seen mostly postoperatively in patients with multiple comorbidities. Small figures make it hard to draw definite statements; however, it stresses once again the necessity for combination antibiotic therapy from the moment of NSTI suspicion. Both the SOFA score at admission to the ICU and the SAPS II score at 24 hours after admission correlated well with mortality. Circulatory and renal dysfunction were the most common organ dysfunctions during the first 24 hours. We recognized a statistically significant association between initial circulatory and liver dysfunction and mortality in the univariate analysis. The current literature is not consistent on this matter: a study by Krieg et al recognized AKI as an independent prognostic parameter for mortality, 4 while Khamnuan et al revealed no correlation between organ dysfunction and mortality. 3 Demographic differences could explain these discrepancies; for example, the number of patients with diabetes mellitus in the first study was significantly higher compared to ours (42% versus 19%). The second study had a surprisingly low mortality rate (9.8%), and only 16% of patients had some form of organ dysfunction. We interpreted the lower C-reactive protein levels in the subgroup of non-survivors more as a sign of deterioration of the liver function and synthesis than as an overall exhaustion of the immune response. Indicators of refractory septic shock with multiple organ dysfunctions as ongoing circulatory dysfunction, a necessity for renal replacement therapy or corticosteroid therapy and a positive fluid balance after the first 24 hours, were significantly associated with higher mortality, all of which were markers of disease severity. Septic shock is still associated with high mortality regardless of the cause, with a systematic review and meta-analysis demonstrating mortality at around 38% across Europe and North America. 28 Similar to the results of another study, 29 the present study could not establish a benefit of using intravenous immunoglobulin therapy. Since only a small number of patients received immunoglobulins, we cannot draw any definitive conclusion. At the moment, there is no recommendation concerning their utilization for the treatment of NSTIs. 6 The major finding of the present study was Asenapine the identification of serum lactate at admission to the ICU as being a good predictor for mortality. This observation is usually consistent with recent studies linking severe hyperlactatemia in general critically ill patients to mortality. 30,31 The failure of serum lactate clearance after 24 hours was a negative predicting factor for survival in the univariate analysis, as well. Computing the ROC Asenapine curves for serum lactate and the SOFA score, we observed better performance Rabbit polyclonal to HMGCL of the Asenapine former in predicting mortality. Our results are much like a recently published study by Chang et al. 32 In the present study, the serum lactate achieved a slightly larger AUC than the SOFA score. Murphy et al exhibited in a small study that serum lactate at presentation could serve as a marker to differentiate NSTIs from other non-necrotizing soft tissue infections, with lactate providing as a potential marker for tissue necrosis. 33 Linking hyperlactatemia to the prediction of mortality is an important finding in our study. Serum lactate is usually a simple parameter that.
