Clinical and laboratory risk indicator for necrotizing fasciitis score in predicting the outcomes in necrotizing soft tissue infection patients
Keywords:LRINEC score, Necrotizing fasciitis, NSTI
Background: Necrotizing soft tissue infection (NSTI) is a serious condition that can be diagnosed on a high index of suspicion and require urgent surgical treatment. NSTI involved epidermis and dermis but more frequently it affects the deeper layer of adipose tissue, fascia, and muscle. NSTI diagnosis and its treatment include emergent surgical intervention and the use of appropriate antibiotics. In this study, we have been evaluated the laboratory risk indicator for necrotizing fasciitis (LRINEC) score in predicting the outcomes in patients of NSTI.
Methods: We have conducted a prospective study of 36 patients with NSTI. The LRINEC score, predisposing factors, etiology, risk factors, causative microbiological organisms have been studied.
Results: LRINEC score >8 is associated with NSTI in all cases. The mortality and morbidity, length of stay including ICU stay increases with an increase in LRINEC score. The most common microorganism was found to be E. coli followed by Klebsiella.
Conclusions: Although, we used the emergent and liberal debridement and appropriate antibiotic and resuscitation. In this study, morbidity, mortality, and length of hospital stay all are increased with respect to the increase in LRINEC score.
Eron LJ. Managing skin and soft tissue infections: expert panel recommendations on key decision points. J Antimicrob Chemother. 2003;52(90001):3-17.
Goldstein EJC, Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705-10.
Das DK, Baker MG, Venugopal K. Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: A retrospective chart review. BMC Infect Dis. 2012;12:6-10.
McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558-65.
Freischlag JA, Ajalat G, Busuttill RW. Treatment of necrotizing soft tissue infections. The need for a new approach. Am J Surg. 1985;149(6):751-5.
Fugitt JB, Puckett ML, Quigley MM, Kerr SM. Necrotizing fasciitis. Radiographics. 2004;24(5):1472-6.
Dellinger EP. Severe necrotizing soft-tissue infections. JAMA. 1981;246(15):1717.
Kaiser RE CF. Progressive necrotizing surgical infections: a unified approach. J Trauma. 1981;21:349-55.
Salcido RS. Necrotizing fasciitis: reviewing the causes and treatment strategies. Adv Skin Wound Care. 2007;20(5):9-11.
Schwartz S, Kightlinger E, De Virgilio C. Predictors of mortality and limb loss in necrotizing soft tissue infections. Am Surg. 2013;79(10):1102-5.
Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. New England Journal of Medicine. 2005 Apr 7;352(14):1445-53.
Howard RJ, Lieb S. Soft-Tissue infections caused by halophilic marine vibrios. Arch Surg. 1988;123(2):245-9.
Goodell KH, Jordan MR, Graham R, Cassidy C, Nasraway SA. Rapidly advancing necrotizing fasciitis caused by Photobacterium (Vibrio) damsela: A hyperaggressive variant. Crit Care Med. 2004;32(1):278-81.
Elliott DC, Kufera JA, Myers RAM. Necrotizing soft tissue infections: Risk factors for mortality and strategies for management. Ann Surg. 1996;224(5):672-83.
May AK. Skin and soft tissue infections. Surg Clin North Am. 2009;89(2):403-20.
Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. Br J Surg. 2014;101(1):119-25.
Hua C, Sbidian E, Hemery F. Prognostic factors in necrotizing soft-tissue infections (NSTI): A cohort study. J Am Acad Dermatol. 2015;73(6):1006-12.
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes. Curr Prob Surg. 2014;51(8):344-62.
Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: Clinical presentation, microbiology, and determinants of mortality. J Bone Jt Surg - Ser A. 2003;85(8):1454-60.
Voros D, Pissiotis C, Georgantas D, Katsaragakis S, Antoniou S, Papadimitriou J. Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg. 1993;80(9):1190-1.
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. Crit Care Med. 2004;32(7):1535-41.
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.
Kulkarni M, Madhu C, Ramya S, Sowmya G, Vijay Kumar G. Necrotizing soft-tissue infection: Laboratory risk indicator for necrotizing soft tissue infections score. J Lab Physic. 2014;6(1):46.
Mukhopadhyay M. Necrotizing soft tissue infections: The role of the LRINEC score. Hell J Surg. 2016;88(1):31-4.
Kalaivani V, Hiremath BV, Indumathi VA. Necrotising soft tissue infection-risk factors for mortality. J Clin Diagn Res. 2013;7(8):1622-65.
Latifi R, Patel AS, Samson DJ. The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections. Eur J Trauma Emerg Surg. 2019;45(5):919-26.
Harikrishnan CP, Vakayil HJ. Necrotizing soft tissue infections: a clinical profile. Int Surg J. 2017;4(3):883-9.
Zhao JC, Zhang BR, Shi K. Necrotizing soft tissue infection: Clinical characteristics and outcomes at a reconstructive center in Jilin Province. BMC Infect Dis. 2017;17(1):1-8.
Narasimhan V, Ooi G, Weidlich S, Carson P. Laboratory risk indicator for necrotizing fasciitis score for early diagnosis of necrotizing fasciitis in Darwin. ANZ J Surg. 2018;88(1-2):45-9.
Fontes RA, Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg. 2000;8(3):151-8.
Kao LS, Lew DF, Arab SN. Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: A multicenter study. Am J Surg. 2011;202(2):139-45.
Lee CY, Kuo LT, Peng KT, Hsu WH, Huang TW, Chou YC. Prognostic factors and monomicrobial necrotizing fasciitis: Gram-positive versus gram-negative pathogens. BMC Infect Dis. 2011;11.
Kincius M, Telksnys T, Trumbeckas D, Jievaltas M, Milonas D. Evaluation of LRINEC scale feasibility for predicting outcomes of Fournier gangrene. Surg Infect. 2016;17(4):448-53.
Bozkurt O, Sen V, Demir O, Esen A. Evaluation of the utility of different scoring systems (FGSI, LRINEC and NLR) in the management of Fournier’s gangrene. Int Urol Nephrol. 2015;47(2):243-8.
Misiakos EP, Bagias G, Papadopoulos I. Early diagnosis and surgical treatment for necrotizing fasciitis: a multicenter study. Front Surg. 2017;4:1-7.
Service H, Park DC. Contemporary clinical trials. Health Serv Res. 2009;30(1):40-6.
Van Stigt SFL, De Vries J, Bijker JB. Review of 58 patients with necrotizing fasciitis in the Netherlands. World J Emerg Surg. 2016;11(1):7-12.
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. Scand J Trauma Resusc Emerg Med. 2017;25(1):1-9.