A study on role of laboratory risk indicator for necrotizing fasciitis score in necrotizing fasciitis

Authors

  • Narendra Prasad Narsingh Department of Surgery, Dr. Bhim Rao Ambedkar Memorial Hospital, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India
  • Anjana Nigam Department of Surgery, Dr. Bhim Rao Ambedkar Memorial Hospital, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India
  • Ramesh Kumar Department of Surgery, Dr. Bhim Rao Ambedkar Memorial Hospital, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, India

DOI:

https://doi.org/10.18203/2349-2902.isj20194575

Keywords:

Necrotizing fasciitis, LRINEC score, Soft tissue infection, Immunocompromised

Abstract

Background: Necrotizing fasciitis (NF) represents a group of highly lethal infection characterized by rapidly progressing inflammation and necrosis. The spectrum of disease ranges from necrosis of the skin to life threatening infection. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score is only scoring system available so far to help us towards making an early and accurate diagnosis.

Methods: The current prospective observational study was conducted in the Surgery OPD and emergency, Department of surgery, Dr. B.R. Ambedkar Memorial Hospital, Raipur, CG, India, during study period October 2017 to September 2018. Sample size was fixed at 100. Blood tests taken on admission were used to calculate the LRINEC score in each case.

Results: In this study 55% of patients with soft tissue infections were categorized as low risk for progression of NF. Necrotizing soft tissue infection (NSTI) occurs in all age groups, ranging from 18 to 75 years. Clinical findings of crepitus were found in 33% of all patients of NSTI. 96% of the patients underwent debridement once, debridement was done twice in 3% of the patients while debridement was not done in 1% of the patients who belonged to high risk group and had no comorbidities. Out of 100, 3 patients underwent amputation. We found that there is mortality rate of 5%.

Conclusions: NF was most severe form of soft tissue infection, potentially life and limb threatening. Early diagnosis of NF is essential for early management and better prognosis of patients.

References

Hefny AF, Eid HO, Al-Hussona M, Idris KM, Abu-Zidan FM. Necrotizing fasciitis: a challenging diagnosis. Eur J Emerg Med. 2007;14(1):50-2.

Avram AM. Case study: necrotizing fasciitis in a patient with obesity and poorly controlled type 2 diabetes. Clin Diabetes. 2002;20:198-200.

Majeski J, Majeski E. Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. South Med J. 1997;90:1065-8.

Lancerotto L, Tocco I, Salmaso R, Vindigni V, Basetto F. Necrotizing fasciitis: Classification, diagnosis and management. J Trauma Acute Care Surg. 2012;72:560-6.

Angoules AG, Kontakis G, Drakoulakis E, Vrentzos G, Granick MS, Giannoudis PV. Necrotising fasciitis of upper and lower limb: a systematic review. Injury. 2007;38(5):19-26.

Soltani AM, Best MJ, Francis CS, Allan BJ, Askari M, Panthaki ZJ. Trends in the incidence and treatment of necrotizing soft tissue infections: an analysis of the national hospital discharge survey. J Burn Care Res. 2014;355:449-54.

Klontz KC, Lieb S, Schreiber M, Janowski HT, Baldy LM, Gunn RA. Syndromes of vibrio vulnificus infections. Clinical and epidemiology features in Florida cases, 1981-1987. Ann Intern Med. 1988;109:318-23.

Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg 2009;208:279-88.

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. 2004;327:1535-41.

Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85:1454-60.

Cheng NC, Wang JT, Chang SC Tai HC, Tang YB. Necrotizing fasciitis caused by Ataphylococcus aureus: the emergence of methicillin-resistant strains. Ann Plast Surg. 2011;67:632-6.

Sharma M, Khatib R, Fakih M. Clinical characteristics of necrotizing fasciitis caused by group G Streptococcus: Case report and review of the literature. Scand J Infect Dis. 2002;34:468-70.

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;518:344-62.

Glass GE, Sheil F, Ruston JC, Butler PEM. Necrotising soft tissue infection in a UK metropolitan population. Ann R Coll Surg Engl. 2015;97(1):46-51.

Surahio AR, Khan AA, Farooq MU, Fatima I, Azhar MZ. Prevalence of necrotizing fasciitis during ramadan and hajj 1427-H J Ayub Med Coll Abbottabad. 2009;21(1):125-9.

Espandar R, Sibdari SY, Rafiee E, Yazdanian S. Necrotizing fasciitis of the extremities: a prospective study. Strat Traum Limb Recon. 2011;6:121-5.

Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, et al. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg. 2016;11:40.

Cheng NC, Tai HC, Chang SC, Chang CH, Lai HS. Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality. BMC Infect Dis. 2015;15:417.

Downloads

Published

2019-10-24

Issue

Section

Original Research Articles