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

Abstract

BACKGROUND:

Necrotizing 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.

METHODS:

A 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.

RESULTS:

A 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).

DISCUSSION:

Early diagnosis, simplified risk stratification and on-time management are vital to achieve better outcomes in patients with NF.

CONCLUSIONS:

Beside 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.

• Authors: Ayman El-Menyar, Mohammad Asim, Insolvisagan N Mudali, Ahammed Mekkodathil, Rifat Latifi, Hassan Al-Thani
• Journal: Scandinavian journal of trauma, resuscitation and emergency medicine (Scand J Trauma Resusc Emerg Med) Vol. 25 Issue 1 Pg. 28 (Mar 07 2017) ISSN: 1757-7241 [Electronic] England
• PMID: 28270166 (Publication Type: Journal Article)

Topics

• Aged
• Decision Support Techniques
• Early Diagnosis
• Fasciitis, Necrotizing (diagnosis)
• Female
• Humans
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Prognosis
• Retrospective Studies
• Risk Assessment