The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role

Abstract

BackgroundNecrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to evaluate the prognostic value of LRINEC scoring in NF patients.MethodsA retrospective analysis was conducted for patients who were admitted with NF between 2000 and 2013. Based on LRINEC points, patients were classified into (Group 1: LRINEC < 6 and Group 2: LRINEC ≥ 6). The 2 groups were analyzed and compared. Primary outcomes were hospital length of stay, septic shock and hospital death.ResultsA total of 294 NF cases were identified with a mean age 50.9 ± 15 years. When compared to Group1, patients in Group 2 were 5 years older (p = 0.009), more likely to have diabetes mellitus (61 vs 41%, p < 0.001), Pseudomonas aeruginosa infection (p = 0.004), greater Sequential Organ Failure Assessment (SOFA) score (11.5 ± 3 vs 8 ± 2, p = 0.001), and prolonged intensive care (median 7 vs 5 days) and hospital length of stay (22 vs 11 days, p = 0.001). Septic shock (37 vs. 15%, p = 0.001) and mortality (28.8 vs. 15.0%, p = 0.005) were also significantly higher in Group 2 patients. Using Receiver operating curve, cutoff LRINEC point for mortality was 8.5 with area under the curve of 0.64. Pearson correlation analysis showed a significant correlation between LRINEC and SOFA scorings (r = 0.51, p < 0.002).DiscussionEarly diagnosis, simplified risk stratification and on-time management are vital to achieve better outcomes in patients with NF.ConclusionsBeside its diagnostic role, LRINEC scoring could predict worse hospital outcomes in patients with NF and simply identify the high-risk patients. However, further prospective studies are needed to support this finding.

Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study

“…Wong et al described the LRINEC that categorizes patients as “high risk” if the score is ≥ 8 [12]. El-Menyar et al published results suggesting the LRINEC score might be useful for risk stratification and prognosis, in which cut-off value for predicting hospital mortality was 8 points in their study [13]. In our study, LRINEC score > 8 showed a statistically significant difference between mortality of the primary and late amputation groups.…”

Necrotizing skin and soft-tissue infections in the intensive care unit

“…The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been proposed as a diagnostic tool for distinguishing NSTI from other non-necrotizing skin and soft-tissue infections, based on the following laboratory tests: C-reactive protein, white blood cell count, haemoglobin, and serum sodium, creatinine and glucose levels. A score !6 was associated with a positive predictive value of 57%e92% and a negative predictive value of 86%e96% [82,83] and associated with worse hospital outcomes [84]. External validity seems to be problematic, however; Fernando et al found that the score had poor sensitivity and concluded that it should not be used to rule out NSTI [85].…”

Impact of clinical interventions in the timely diagnosis and therapeutic approach of necrotizing soft tissue infections

“…The laboratory risk indicator for necrotizing fasciitis (LRINEC) is a strategy that considers C-reactive protein, white blood cell count, hemoglobin concentration, sodium, creatinine and serum glucose to establish a risk score. 5 The above parameters are integrated in a risk indicator of necrotizing fasciitis. 5 This score has had limited acceptance by the medical community, which suffers from the lack of correlation with reality, where leukocytosis and hyponatremia do not occur simultaneously.…”

“…5 The above parameters are integrated in a risk indicator of necrotizing fasciitis. 5 This score has had limited acceptance by the medical community, which suffers from the lack of correlation with reality, where leukocytosis and hyponatremia do not occur simultaneously. It is important to note that this tool was developed exclusively with laboratory parameters ignoring physical findings; in this sense, it is difficult to reproduce results in the scenario of a disease with such variability in its clinical presentation.…”

“…A high index of clinical suspicion remains the paramount. 5 The scope of microbiological studies in early diagnosis of NSTIs is limited. Fluid aspiration for detection of microorganisms in initial stages has low VPP.…”