Laboratory risk indicator for necrotizing fasciitis: an objective scoring system as a tool for early diagnosis of necrotizing fasciitis

Authors

  • Syed Saad Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India http://orcid.org/0000-0003-4445-2757
  • Panchami P. Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India
  • Gulamnabi . Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20215139

Keywords:

Necrotizing fasciitis, Laboratory risk indicator for necrotizing fasciitis, Scoring system

Abstract

Background: Necrotizing soft tissue infections are often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The mortality of 30-40% reflects the inadequacy of early recognition of necrotizing soft tissue infections. This study emphasizes on the search for a tool that reliably and rapidly identifies patients with NF. An objective of current study was to validate the LRINEC score as a tool for early distinguishing of necrotizing fasciitis from other soft tissue infections.

Methods: Prospective clinical study analysis of outcome of sixty of patients with soft tissue infections were evaluated based on LRINEC. Based on their LRINEC score, the patients were categorized as low, intermediate and high risk for the onset of necrotizing fasciitis.

Results: A total of 60 patients with soft tissue infections were prospectively evaluated and categorized on the basis of LRINEC score 45 patients in low risk category, 7 in Intermediate risk and 8 patients in high risk group. In terms of outcome, all cases (including positive tissue diagnosis cases) in low risk and intermediate risk groups and 2 cases in high risk group were improved with surgical debridement/fasciotomy. The cutoff of LRINEC ≥6 has better sensitivity and specificity in identifying the risk of the patient.

Conclusions: LRINEC scoring system has a better positive predictive value in identifying the onset and risk strategizing of necrotizing fasciitis.

Author Biography

Syed Saad, Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India

General Surgery

Post Graduate

References

Descamps V, Aitken J, Lee MG. Hippocrates on necrotising fasciitis. Lancet. 1994;344:556.

Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279-88.

File TMJ, Tan JS .Treatment of skin and soft-tissue infections. Am J Surg. 1995;169(5):27S

Wilson B. Necrotising fasciitis. Am Surg. 1952;18:416-31.

Lille ST, Sato TT, Engrav LH, Foy H, Jurkovich GJ . Necrotizing soft tissue infections: obstacles in diagnosis. J Am Coll Surg.1996;182:7-11.

Ryssel H, Germann G, Riedel K, Köllensperger E. Surgical concept and results of necrotizing fasciitis. Chirurg. 2007;78:1123-9

Swain R, Hatcher J, Azadian B et al. A five-year review of necrotizing fasciitis in a tertiary referral unit. Ann R Coll Surg Engl.2013;95: 57-60.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The 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.

Jones J. Investigation upon the nature, causes and treatment of hospital gangrene as it prevailed in the confederate armies 1861-1965. New York, U. S. Sanitary Commission. J Am Coll Surg. 1996;182:7-11.

Meleney FL. Hemolytic streptococcal gangrene. Arch Surg. 1924;9:317-64.

McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558-63.

Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279-88.

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(5):397-401.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC 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 R Coll Surg Engl. 2017;99(5):341-6.

Liao CI, Lee YK, Su YC, Chuang CH, Wong CH. Validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for early diagnosis of necrotizing fasciitis. Tzu Chi Med J. 2012;24(2):73-6.

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Published

2021-12-28

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Original Research Articles