Early Diagnosis of Necrotizing Fasciitis using Laboratory Risk Indicator of Necrotizing Fasciitis (LRINEC) Score

Abstract

Background: Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia. Early diagnosis of NF is essential, as delayed diagnosis leads to higher rates of amputation and mortality. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score is used to obtain early diagnosis in order to reduce morbidity and mortality rates.

Objective: The laboratory risk indicator for necrotizing fasciitis (LRINEC) score was introduced in 2004 and is useful in achieving early recognition of necrotizing fasciitis. The authors investigated the efficacy of the LRINEC score inearly diagnosis and management of NF.

Material and method: This prospective validation cohort study included patients admitted tothe Surgery Department of Rajavithi Hospital from December 2013 to December 2015. Medical records, microbiological tests and laboratory parameters were examined, and LRINEC score of all patients was calculated on admission.

Results: Of 164 patients examined, 61 were diagnosed with necrotizing fasciitis and the other 103 were confirmed as cases of cellulitis. The results showed that for patients who had duration of symptoms >8 hours, the optimal cut-off LRINEC score of >4 was effective in predicting NF. The sensitivity was 85.42%, specificity was 75.31%, positive predictive value (PPV) was 67.21%, negative predictive value (NPV) was 89.71% and accuracy was 79.07%. The overall amputation rate was significantly higher (p = 0.018) in NF patients.

Conclusion: The LRINEC score is a diagnostic tool which can assist in differentiating NF from cellulitis. Many adjuncts have been described which can help to achieve early recognition of the disease, and the LRINEC score is a reliable tool for use by surgeons in identifying diseases that can develop into NF.