Necrotizing fasciitis: diagnostic and prognostic value of laboratory risk indicator for necrotizing fasciitis score

Angir Soitkar, Murtaza Akhtar, Abhay Choudhari, Satish Deshmukh


Background: Necrotizing fasciitis (NF) is a potentially life threatening disease. Delayed recognition and surgical intervention is directly linked to increased mortality. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score, a laboratory oriented tool has potential to prevent morbidity and mortality but there exhibits a controversy regarding its utility which needs re-evaluation to prove it’s utility.

Methods: A tertiary care hospital based observational study aims to evaluate diagnostic and prognostic value of LRINEC score. Patient above 18 years clinically diagnosed as SSTI and confirmed as NF histopathologically without co-morbidities were enrolled as subjects. Clinical evaluation and laboratory oriented LRINEC score were the study factors. Outcome factors were morbidity and mortality and histopathological confirmation of NF. Patients were analyzed as cellulitis and NF with identification of factors associated with NF; Univariate analysis with Kaplan-Meier survival analysis and ROC plotting was done.

Results: Total 166 patients were enrolled with mean age of 47.14±15.76 years and 2:1 is the male : female ratio and. A total of 117 patients were diagnosed as Cellulitis and 49 patients were NF. Clinically Discharge, fever and cuticular necrosis was statistically associated with NF (p<0.01). Mortality in NF was 22.4% and no mortality in Cellulitis. Mean LRINEC score in cellulitis and NF was 1.95±0.972 and 7.57±1.51 (p<0.01). Survival analysis graph and ROC showed LRINEC score of 6 as diagnostic and score ≥9 as poor prognostic indicator.

Conclusions: LRINEC score is a useful diagnostic and prognostic tool in patients of NF.


Skin and soft tissue infection, Cellulitis, Necrotizing fasciitis, LRINEC score, Prognosis

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Quirk WF, Sternbach G. Joseph Jones: infection with flesh eating bacteria. J Emerg Med. 1996;14(6):747-53.

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

Wilson B. Necrotizing Fasciitis. Am Surg. 1952;18:416-31.

Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41:1373-406.

Canbaz H, Çağlıkülekçi M, Altun U, Dirlik M, Türkmenoğlu Ö, Taşdelen B, et al. Fournier’s gangrene: analysis of risk factors affecting the prognosis and cost of therapy in 18 cases. Turkish J Trauma Emerg Surg. 2010;16(1):71-6.

Turhan O, Büyüktuna SA, İnan D, Saba R, Yalçın AN. Clinical evaluation of forty-four patients with necrotizing fasciitis. Turkish J Trauma Emerg Surg. 2011;17(1):29-32.

Faucher LD, Morris SE, Edelman LS, Saffle JR. Burn center management of necrotizing soft-tissue surgical infections in unburned patients. Ame J Surg. 2001;182(6):563-9.

Wilson HD, Haltalin KC. Acute necrotizing fasciitis in childhood: report of 11 cases. Am J Dis Children. 1973;125(4):591-5.

Saz EU, Anik A, Tanriverdi HI, Anik A, Ergün O. Pseudomonas necrotizing fasciitis following an intramuscular injection in an immunocompetent child. Pediatrics International. 2010;52(2):e114-6.

Korhan T, Neslihan C, Atahan C, Hakan Y, Cemalettin E, Irfan B, Halit O, Recep G. Idiopathic necrotizing fasciitis: risk factors and strategies for management. The American Surgeon. 2005;71(4):315-20.

Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogenesis and treatment. Expert review of anti-infective therapy. 2005;3(2):279-94.

Schuster L, Nuñez DE. Using clinical pathways to aid in the diagnosis of necrotizing soft tissue infections synthesis of evidence. Worldviews on Evidence‐Based Nursing. 2012;9(2):88-99.

Corbin V, Vidal M, Beytout J, Laurichesse H, D'Incan M, Souteyrand P, et al. Prognostic value of the LRINEC score (Laboratory Risk Indicator for Necrotizing Fasciitis) in soft tissue infections: a prospective study at Clermont-Ferrand University hospital. Ann Dermatol Venereol. 2010;137(1):5-11..

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.

Chao WN, Tsai SJ, Tsai CF, Su CH, Chan KS, Lee YT, et al. The Laboratory Risk Indicator for Necrotizing Fasciitis score for discernment of necrotizing fasciitis originated from Vibrio vulnificus infections. J Trauma Acute Care Surg. 2012;73(6):1576-82.

Tilkorn DJ, Citak M, Fehmer T, Ring A, Hauser J, Benna SA, et al. Characteristics and differences in necrotizing fasciitis and gas forming myonecrosis: a series of 36 patients. Scandinavian J Surg. 2012;101(1):51-5.

Shaikh N. Necrotizing fasciitis: a decade of surgical intensive care experience. Indian J Crit Care Med. 2006;10(4):225.

Mukhopadhyay M, Saha AK, Biswas RR, Biswas S. A clinicopathological study of necrotizing fasciitis. Diabetes. 2011;17:34.

Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Braz J Infectious Dis. 2014;18(2):137-43.

Çolak E, Ozlem N, Kucuk GO, Aktimur R, Kesmer S. Laboratory risk indicators for necrotizing fasciitis and associations with mortality. Turkish J Emerg Med. 2014 1;14(1):15-9.

Borschitz T, Schlicht S, Siegel E, Hanke E, von Stebut E. Improvement of a clinical score for necrotizing fasciitis:‘pain out of proportion’and high CRP levels aid the diagnosis. PloS one. 2015;10(7):e0132775.

Bruun T, Oppegaard O, Hufthammer KO, Langeland N, Skrede S. Early response in cellulitis: a prospective study of dynamics and predictors. Clinical Infectious Diseases. 2016;63(8):1034-41.

Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical care medicine. 2006;34(6):1589-96.

van Stigt SF, de Vries J, Bijker JB, Mollen RM, Hekma EJ, Lemson SM, et al. Review of 58 patients with necrotizing fasciitis in the Netherlands. World Journal of Emergency Surgery. 2016;11(1):21.

Njim T, Aminde LN, Agbor VN, Toukam LD, Kashaf SS, Ohuma EO. Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study. BMC infectious diseases. 2017;17(1):418.

Muthusami A, Krishnaswamy J, Sattar R. A clinical study of non-diabetic soft tissue infections: risk factors for mortality and morbidity. Int Surg J. 2017;5(1):216-20.

Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A. Necrotizing fasciitis: risk factors of mortality. Risk management and healthcare policy. 2015;8:1.

Tarchouli M, Bounaim A, Essarghini M, Ratbi MB, Belhamidi MS, Bensal A, Zemmouri A, Ali AA, Sair K. Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases. Canadian Urol Assoc J. 2015;9(11-12):E800.

Mittal S, Singh B, Mittal R, Singh K. A prospective study of cases with necrotising fasciitis: our experience at a tertiary care teaching hospital. International Surgery Journal. 2017;4(10):3326-9.

Deshpande SG, Grover A, Shahapurkar VV, Shinde RK. Limb cellulitis in rural setting in India: a case control study. International Surgery Journal. 2017; 24;4(8):2751-5.

Nassaji M, Ghorbani R, Ghashghaee S. Risk factors of acute cellulitis in adult patients: A case-control study. Eastern J Med. 2016;2016:26-30.

Mohammad NE, Elshimi E, Galal SA, Mohammad MH, Kotb HG. Skin Complications of Obesity: Controlled Prospective Study. Clin Dermatol Res J. 2017;2:2.

Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann Royal Coll Surg England. 2017;99(5):341-6.

El-Menyar A, Asim M, Mudali IN, Mekkodathil A, Latifi R, Al-Thani H. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role. Scandinavian journal of trauma, resuscitation and emergency medicine. 2017;25(1):28.