Study of the effectiveness of laboratory risk indicator for necrotizing fasciitis scoring system in the diagnosis of necrotizing fasciitis among patients presenting with soft tissue infections
Keywords:LRINEC, Necrotizing fasciitis, Necrotizing soft tissue infection
Background: Necrotizing soft tissue infection (NSTI) is an uncommon but life threatening disease with a high mortality rate. Delay in diagnoses and in surgery for debridement is associated with increased mortality rates. Hence here we would like to use this scoring system - laboratory risk indicator for necrotizing fasciitis (LRINEC) in patients presenting to our hospital with necrotizing soft tissue infection and if found to have good predictive values, it would be a boon to developing countries like India where the mortality of the disease is high (7% to 76%).
Methods: Patients presenting with symptoms suggestive of soft tissue infection underwent clinical examination and basic laboratory investigations. Following which, information collected using semi structured proforma cum observational checklist. LRINEC scoring system applied to each of the study subjects at admission. The confirmatory diagnosis of necrotizing fasciitis done on patients who undergo surgery vide histopathology, irrespective of the result of the LRINEC scoring system. Tissue cultures and sensitivity patterns analyzed.
Results: A total of 100 patients were enrolled. LRINEC score has an ability to diagnose necrotizing fasciitis from other soft tissue infections. High LRINEC score had more incidences of features of sepsis. Presence of the co morbidities tended to increase the LRINEC score. And defines patients with a high LRINEC score of >8 had higher mortality rate.
Conclusions: LRINEC score is a simple clinical tool for the diagnosis of necrotizing fasciitis from other soft tissue infections. LRINEC scoring system and clinical assessment should be used concurrently for diagnosing necrotizing fasciitis from other soft tissue infections.
Kaul R, McGeer A, Low DE, Green K, Schwartz B. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med. 1997;103:18-24.
Morgan MS. Diagnosis and Management of Necrotizing Fasciitis. J Hosp Infect. 2010;75(4)4:249-57.
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;80:1190-1.
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.
Rea WJ, Wyrick WJ. Necrotizing Fasciitis. Ann Surg. 1970;172:957-64.
Masjeski JA, Alexander JW. Early diagnosis, nutritional support and immediate extensive debridement improve survival in necrotizing fasciitis. Am J Surg. 1983;145:781-7.
Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg. 1998;64:397-400.
Stamenkovic I, Lew PD. Early recognition of potentially fatal necrotizing fasciitis: the use of frozen section biopsy. N Engl J Med. 1984;310:1689-93.
Green RJ, Dafoe DC, Raffin TA. Necrotizing Fasciitis. Chest. 1996;110:219-29.
Wong CH, Khin LW, Heng KS, Tan KC, Low Co.The LRINEC [Laboratory Risk Indicator for Necrotizing Fascitis]score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32:1535-41.
Holland HJ. Application of the Laboratory Risk Indicator in Necrotizing Fasciitis [LRINEC] score to patients in a tropical tertiary referral centre. Anaesth Intensive Care. 2009;37:588-92.
Tsai YH, Hsu RW, Huang TJ. Laboratory indicators for early detection and surgical treatment of vibrio necrotizing fasciitis. Clin Orthop Relat Res. 2010;468:2230-7.
Huang KC, Hsieh PH, Huang KC. Vibrio necrotizing soft tissue infection of the upper extremity: factors predictive of amputation and death. J Infect. 2008;57:290-7.
Corbin V, Vidal M, Beytout J, Laurichesse H. D’ Incan M, Souteyrand P, et al. Prognostic value of the LRINEC [Laboratory Risk Indicator in Necrotizing Fascitis] in soft tissue infections: a prospective study at Clemont-Ferrand University hospital. Ann Dermatol Venereol. 2010;137:5-11.
Su YC, Chen HW, Hong YC, Chen CT, Hsiao CT, Chen IC. Laboratory Risk Indicator in Necrotizing Fascitis score and the outcomes. ANZ J surg. 2008;78:968-72.
Meleney F. Hemolytic Strep gangrene. Arch Surg. 1924; 9:317-64.
Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Necrotizing fasciitis: epidemiology and clinical predictors for amputation. Int J Gen Med. 2015;8:195-202.