DOI: http://dx.doi.org/10.18203/2349-2902.isj20184096

Correlation of the laboratory risk indicators for necrotizing fasciitis (LRINEC) score with the clinical features and surgical management of necrotizing soft tissue infections

Neeraj Kumar, Raghav Garg, Rajesh Kumar Soni, Ratnakar Namdeo

Abstract


Background: Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to correlate the clinical features of NSTI with the LRINEC score, its application to distinguish Necrotizing Fasciitis (NF) from other non NSTI and its utility in early surgical management of NSTI.

Methods: Patients were evaluated for various symptoms and signs at the time of admission and certain laboratory parameters were assessed. LRINEC score was then calculated. Correlation of the management and severity of infections with respective LRINEC score was then found out.

Results: LRINEC score for predicting conservative management of NSTI has a sensitivity of 81.8% and specificity of 98% while for predicting amputation and mortality shows a sensitivity of 100% and specificity of 84.5%.

Conclusions: The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis.


Keywords


Infections, LRINEC, Necrotizing, Soft tissue

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References


Ahn C. Necrotizing fasciitis: reviewing the causes and treatment strategies. Advances in skin and wound care. 2007;20(5):288-93.

Trent JT, Kirsner RS. Diagnosing necrotizing fasciitis. Advances in skin and wound care. 2002;15(3):135-8.

Sawyer MD, Dunn DL. Serious bacterial infections of the skin and soft tissues. Curr Opin Infect Dis. 1995;8:293.

Misiakos EP, Bagias G, Patapis P. Current concepts in the management of necrotizing fascitis. Front Surg. 2014;1:36.

Mishra SP, Singh S, Gupta SK. Necrotizing soft tissue infections: Surgeon’s prospective. Int J Inflamm. 2013;2013.

Su YC, Chen HW, Hong YC, Chen CT, Hsiao CT, Chen IC. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. ANZ J Surg. 2008;78(11):968-72.

Phan HH, Cocanour CS. Necrotizing soft tissue infections in the intensive care unit. Crit Care Med. 2010;38(9):460-8.

Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344-62.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Critical Care Med. 2004;32(7):1535-41.

Vijayakumar A, Pullagura R, Thimmappa D. Necrotizing fasciitis: diagnostic challenges and current practices. ISRN Infectious Diseases. 2014;2014.

Goldstein EJC, Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705-10.

Paramythiotis D, Koukoutsis H, Harlaftis N. Necrotizing soft tissue infections. Surgical Practice. 2007;11:17-28.

Wall DB, Klein SR, Black S. A simple model to help distinguish necrotizing fascitis from non necrotizing soft tissue infection. J Am Coll Surg. 2000;191(3):227-31.

Anaya DA, McMahon K, Nathens AB. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005;140:151-57.

Avalahalli MG, Muniraja PK, Khalid MS, Kaverappa K, Devaraj L, Rao A. Comparative study of LRINEC score: procalcitonin and LRINEC score: C-Reactive Protein in predicting duration of hospital stay and severity in necrotizing fascitis. J Evolution Med Dent Sci. 2016;5(51):3348-51.

Borschitz T, Schlicht S, Siegel E. Improvement of a clinical score for necrotizing fascitis: ‘Pain out of proportion’ and high CRP levels aid the diagnosis. PLoS ONE. 2015;10(7):1-13.

Watson H, Hassan S, Davies M. Outcomes following necrotizing fascitis: an 8-year review. Res J Infect Dis. 2014;2:2-5.

Mukhopadhyay M. Necrotizing soft tissue infections: The role of the LRINEC score. Hellenic J Surg. 2016;88(1):31-4.