To assess the diagnostic accuracy of LRINEC Score for prediction of necrotizing fasciitis in patients presenting with clinical skin and subcutaneous tissue infections
DOI:
https://doi.org/10.61529/idjp.v33i2.313Abstract
Background: Necrotizing fasciitis is an inflammatory disease that causes the skin, soft tissues, and fascia to break down. A strain of Streptococcus pyogenes bacteria is frequently the source of it, however mixed infections involving coliforms, anaerobes, and Gram-negative bacteria can also be to blame. Even with contemporary medical care, necrotizing fasciitis is associated with a significant fatality rate. The objective of this study is to determine the diagnostic accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting necrotizing fasciitis in patients with cutaneous and subcutaneous tissue infections.
Material and Methods: This Cross-sectional study was conducted at Combined Military Hospital, Rawalpindi from May 2021 to October 2022. Hundred cases of probable necrotizing fasciitis coupled with clinical cutaneous or subcutaneous infections were included. They underwent clinical examinations and blood investigation (Sodium, Hemoglobin, total white cell count, Glucose, Creatinine, C-reactive protein (CRP), and biopsy for histopathology). Patients under the age of 15 or older than 75, with soft-tissue infections, undergone surgical debridement and without the result of CRP in the initial 48 hours of retention were excluded. LRINEC score ≥6 was used for labelling a case with necrotizing fasciitis. LRINEC score was then compared with results of histopathology and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using SPSS version 23.
Results: 35 (35%) out of total belonged to the age group between 46-55 years. Male and female ratio were 64 (64%) and 36 (36%). Diabetes mellitus was the most common etiological cause occurring in 56 (56%) patients. The sensitivity of the LRINEC scoring system was 79.7% and the specificity noted was 87.8%. The PPV was 90.4% and the NPV came out to be 75%.
Conclusions: LRINEC scoring system has a significant sensitivity and reasonable specificity in diagnosing cases of Necrotizing fasciitis among patients with severe soft-tissue infection. LRINEC score can be used for predicting the outcome of such cases.
Keywords: Laboratory risk indicator for necrotizing fasciitis (LRINEC), Necrotizing fasciitis, Subcutaneous tissue infections
References
Tessier JM, Sanders J, Sartelli M, Ulrych J, De Simone B, Grabowski J, et al. Necrotizing soft tissue infections: A focused review of pathophysiology, diagnosis, operative management, antimicrobial therapy, and pediatrics. Surg Infect. 2020; 21(2): 81-93.
DOI: https://doi.org/10.1089/sur.2019.219
Desta R, Yee J. Necrotizing fasciitis. JETem. 2020; 5(2): 1-25. DOI: https://doi.org/10.21980/J84M1D
Fernando SM, Tran A, Cheng W, Rochwerg B, Kyeremanteng K, Seely AJ, et al. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: A systematic review and meta-analysis. Ann Surg. 2019; 269(1): 58-65.
DOI: https://doi.org/10.1097/sla.0000000000002774
Sophy FJ, Devi RL, Anubhav MP. Validation of laboratory risk indicator for necrotizing fasciitis scoring system for diagnosis of necrotizing fasciitis in patients presenting with soft-tissue infections. Int J Sci Study. 2021; 8(10): 166-9.
Chen PC, Tsai SH, Wang JC, Tzeng YS, Wang YC, Chu CM, et al. An elevated glycemic gap predicts adverse outcomes in diabetic patients with necrotizing fasciitis. PLoS One. 2019; 14(10): e0223126.
DOI: https://doi.org/10.1371/journal.pone.0223126
Harasawa T, Kawai-Kowase K, Tamura JI, Nakamura M. Accurate and quick predictor of necrotizing soft tissue infection: usefulness of the LRINEC score and NSTI assessment score. J Infect Chemother. 2020; 26(4): 331-4. Doi: https://doi.org/10.1016/j.jiac.2019.10.007
Kumar M, Lal M. Predictors of mortality in necrotizing fasciitis. Formosan J Surg. 2021; 54(2): 52-60.
DOI: http://dx.doi.org/10.4103/fjs.fjs_43_20
Wei XK, Huo JY, Yang Q, Li J. Early diagnosis of necrotizing fasciitis: Imaging techniques and their combined application. Int Wound J. 2024; 21(1): e14379.
DOI: https://doi.org/10.1111/iwj.14379
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.
DOI: https://doi.org/10.1097/01.ccm.0000129486.35458.7d
Wall DB, de Virgilio C, Black S, Klein SR. Objective criteria may assist in distinguishing necrotizing fasciitis from non-necrotizing soft tissue infection. The Am J Surg. 2000; 179(1): 17-20.
DOI: https://doi.org/10.1016/S0002-9610(99)00259-7
Choi HK, Seo GH, Han E. The incidence and seasonal variation of necrotizing fasciitis in Korea: A nationwide cross-sectional study. Clin Microbiol Infect. 2020; 26(8): 1090-e1. DOI: https://doi.org/10.1016/j.cmi.2020.01.002
Stevens DL, Bryant AE, Goldstein EJ. Necrotizing soft tissue infections. Infect Dis Clin North Am. 2021; 35(1):135-55.
DOI: https://doi.org/10.1016/j.idc.2020.10.004
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.
DOI: https://doi.org/10.1097/ta.0b013e318270d761
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.
DOI: https://doi.org/10.1111/j.1445-2197.2008.04713.x
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 2009; 137 (1): 5-11. DOI: https://doi.org/10.1016/j.annder.2009.12.002
Swain RA, Hatcher JC, Azadian BS, Soni N, De Souza B. A five-year review of necrotising fasciitis in a tertiary referral unit. Ann R Coll Surg Engl. 2013; 95(1): 57-60.
DOI: https://doi.org/10.1308/003588413X13511609956093
Colak E, Ozlem N, Kucuk GO, Aktimur R, Kesmer S. Laboratory risk indicators for necrotizing fasciitis and associations with mortality. Turk J Emerg Med. 2014; 14(1): 15-9. DOI: https://doi.org/10.5505/1304.7361.2014.55476
Wong C, Wang Y. The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis. 2005; 18: 101–6.
DOI: https://doi.org/10.1097/01.qco.0000160896.74492.ea
Harasawa T, Kawai-Kowase K, Tamura JI, Nakamura M. Accurate and quick predictor of necrotizing soft tissue infection: usefulness of the LRINEC score and NSTI assessment score. J Infect Chemother. 2020; 26(4): 331-4. DOI: https://doi.org/10.1016/j.jiac.2019.10.007
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