Modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) Score System in Diagnosing Necrotizing Fasciitis: A Nested Case–Control Study

Wu, Haotian; Liu, Song; Li, Chunxia; Song, Zhaohui

doi:10.2147/idr.s313321

Cited by 16 publications

(19 citation statements)

References 20 publications

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“…12,[14][15][16][17] Wu et al developed a modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) scoring system, which reported a better diagnostic value and published on June 2021. 18 The goal of this study is to compare a matched retrospective cohort of patients with LE NSTI to those with severe cellulitis. Within these two groups of similar m-LRINEC scores, this study identifies factors associated with NSTI rather than cellulitis to help in the clinical differentiation between these diagnoses that require different treatments.…”

Section: Introductionmentioning

confidence: 99%

Differentiating Lower Extremity Necrotizing Soft Tissue Infection from Severe Cellulitis by Laboratory Parameters and Relevant History Points

Wu¹,

Chang²

2021

IDR

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Background: Necrotizing soft tissue infection (NSTI) of the lower extremity (LE) is a rapidly progressing infection that requires early diagnosis and prompt treatment to decrease risks of loss of limb or life. Clinical presentation, particularly of early NSTI, can appear similar to severe cellulitis. The purpose of this study is to identify factors that are associated with NSTI rather than severe cellulitis to differentiate patients with similar clinical presentation. Methods: This retrospective cohort design study compares patients finally diagnosed with LE NSTI versus those diagnosed with severe cellulitis. Cohorts were matched using the modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) score in the setting of LE soft tissue infection. Laboratory values, vital signs, subjective symptoms, and social factors including substance abuse were recorded. Univariate and multivariate analyses were performed. Results: Multivariate statistical analysis and clinical interpretation of data identified four factors more associated with a diagnosis of NSTI than severe cellulitis: elevated lactate, a patient-reported history of fever, male gender, and intravenous substance user. Conclusion:In patients with lower extremity infections, the clinical presentation of NSTI and severe cellulitis may appear similar. In this retrospective cohort of patients matched with m-LRINEC scores, elevated lactate, subjective fever, male gender, and intravenous substance abuser were significantly associated with NSTI rather than severe cellulitis. Further studies of these factors in the clinical setting can help tailor the differential diagnosis in the care of patients with severe lower extremity infections. Matched with m-LRINEC scores, elevated lactate, subjective fever, male gender, and intravenous substance abuser were significantly associated with NSTI rather than severe cellulitis. Further studies of these factors in the clinical setting can help tailor the differential diagnosis in the care of patients with severe lower extremity infections.

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Section: Introductionmentioning

confidence: 99%

Differentiating Lower Extremity Necrotizing Soft Tissue Infection from Severe Cellulitis by Laboratory Parameters and Relevant History Points

Wu¹,

Chang²

2021

IDR

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“…Necrotizing soft tissue infections are rare diseases, with NF being its most common form with an incidence of 0.3-15 cases per 100,000 inhabitants 3 . Despite advances in research practices, both on diagnosis and also on treatment, NF is associated with a mortality rate around 25-35% of cases and an amputation rate between 15 and 30% 3,10 . Mortality is even more pronounced in those who develop TSS or septic shock.…”

Section: Epidemiologymentioning

confidence: 99%

“…3), hemorrhagic blisters (Fig. 3), ulceration, necrosis, discharge of brownish fluid compared in the literature to "dishwater," especially after surgical debridement of the affected areas, hypoesthesia, sepsis, multi-organ failure, shock and death [1][2][3]5,10 . A meta-analysis published in 2018 12 , aiming to report on the presence of fever, hemorrhagic blisters, and hypotension in the diagnostic acuity of necrotizing skin and soft tissue infections, concluded that these three clinical findings have a low sensitivity to identify them with fever, hemorrhagic blisters and hypotension being present on 46%, 25.2%, and 21%, respectively.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Type II necrotizing fasciitis

Martinez¹,

Pinho²

2023

PJDV

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Necrotizing fasciitis integrates a series of necrotizing soft tissue infections. Type II necrotizing fasciitis (NF) is due to an infection by group A Streptococcus, which can be associated with Staphylococcus aureus, and may evolve to toxic shock syndrome, with high morbidity and mortality negatively influenced by delay in diagnosis and institution of appropriate surgical therapy. At an early stage, the clinical presentation may not be explicit; therefore, a high index of suspicion is essential in order to diagnose, initiate antibiotic therapy and, most importantly, perform surgical debridement in a timely manner, which is crucial for optimizing the patient's prognosis. The purpose of this article is to execute a narrative review about type II NF, namely in terms of its clinical manifestations, diagnostic and therapeutic approach, through the analysis of recent information on the subject.

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“…The following supporting information can be downloaded at: , Table S1: References in the literature-based search for variables. References [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ] are cited in the supplementary materials.…”

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confidence: 99%

Classification Model for Diabetic Foot, Necrotizing Fasciitis, and Osteomyelitis

Kim

Yoo

Lee

et al. 2022

Biology

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Diabetic foot ulcers (DFUs) and their life-threatening complications, such as necrotizing fasciitis (NF) and osteomyelitis (OM), increase the healthcare cost, morbidity and mortality in patients with diabetes mellitus. While the early recognition of these complications could improve the clinical outcome of diabetic patients, it is not straightforward to achieve in the usual clinical settings. In this study, we proposed a classification model for diabetic foot, NF and OM. To select features for the classification model, multidisciplinary teams were organized and data were collected based on a literature search and automatic platform. A dataset of 1581 patients (728 diabetic foot, 76 NF, and 777 OM) was divided into training and validation datasets at a ratio of 7:3 to be analyzed. The final prediction models based on training dataset exhibited areas under the receiver operating curve (AUC) of the 0.80 and 0.73 for NF model and OM model, respectively, in validation sets. In conclusion, our classification models for NF and OM showed remarkable discriminatory power and easy applicability in patients with DFU.

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Modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) Score System in Diagnosing Necrotizing Fasciitis: A Nested Case–Control Study

Cited by 16 publications

References 20 publications

Differentiating Lower Extremity Necrotizing Soft Tissue Infection from Severe Cellulitis by Laboratory Parameters and Relevant History Points

Differentiating Lower Extremity Necrotizing Soft Tissue Infection from Severe Cellulitis by Laboratory Parameters and Relevant History Points

Type II necrotizing fasciitis

Classification Model for Diabetic Foot, Necrotizing Fasciitis, and Osteomyelitis

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