The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Scoring: Diagnostic and Potential Prognostic Role

Abstract

Introduction: Necrotizing fasciitis (NF) is an progressive and deadly soft tissue infection with necrosis, usually affecting the subcutaneous tissue and fascia. It has severe morbidity and mortality1. About thirteen per million population are thought to be hospitalized every year for Necrotizing Fasciitis, out of which around twenty to thirty percent die from the disease.Materials and Methods: This is a hospital-based observational study conducted on 101 patients presenting with symptoms suggestive of soft tissue infections in the department of General Surgery, Justice K.S. Hegde Charitable Hospital is attached to K S Hegde Medical Academy, a unit of Nitte (Deemed to be University), Mangalore. The study was conducted from January 2019 to June 2020. Information regarding the demographics & covariates of soft tissue infections was collected using a pretested semi-structured proforma cum observational checklist. LRINEC scoring system was applied to each of the study subjectsResults: The objective of our study is to use the LRINEC scoring system in early detection and evaluate the prognostic value of patients with necrotizing fasciitis. With a Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score >6, the sensitivity was 46% (95% confidence interval 31% to 61.61%), specificity was 98.33% (95% confidence interval 95% to 101%), positive predictive value was 95% (95% confidence interval 85% to 104%),and negative predictive value was 72.84% (95% confidence interval 63% to 82%).The area under the receiver operating characteristic curve for accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was 0.696 (95% CI 0.640 to 0.751).Conclusion: The LRINEC score is an outstanding diagnostic tool for distinguishing necrotizing fasciitis from other serious infections of soft tissue. Patients with an LRINEC score of≥6 have a higher rate of both morbidity and surgical debridement.