Introduction: Necrotizing soft-tissue infections are often fatal, characterized by extensive necrosis of the fascia and subcutaneous tissues. To aid the early diagnosis of necrotizing fasciitis (NF), there is a Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system for the early diagnosis of NF. Our study was undertaken to evaluate LRINEC score, based on routine laboratory investigations that are readily available, that could help distinguish NF from other soft-tissue infections. Materials and Methods: The study was conducted on all inpatients, admitted with features of soft-tissue infections suspected to have NF and later underwent wound debridement or amputation in a tertiary care hospital. LRINEC score more than or equal to 6 was considered as case and the score <6 considered as control. Both were treated with intravenous (IV) antibiotics, IV fluids and surgical intervention based on their clinical findings and outcome. The confirmatory diagnosis for NF was done through culture of tissue and other body fluids. Results: The cutoff value of LRINEC for predicting NF was 6 with sensitivity of 85.7% and specificity of 70.7%. The negative predictive value of LRINEC-OC was 87.9% and positive predictive value (PPV) 66.7%. The accuracy was 76.8%. Conclusion: LRINEC scoring system has a better PPV in identifying the onset of NF and risk strategizing of the patients with severe soft-tissue infections. We recommend LRINEC score to be used as a predictor in the diagnosis of NF. Multi-disciplinary team may guide immediate operative and supportive management, thereby improving the clinical outcome of the patient.

Introduction: Acute appendicitis is a very common cause of acute abdomen and the diagnosis is essentially clinical. A decision to operate based on clinical suspicion alone can result in removal of a normal appendix; whereas, if left untreated, appendicitis can result in necrosis and perforation. Therefore, improving the diagnostic accuracy of appendicitis is a need of the hour. This study was conducted to evaluate hyperbilirubinaemia in acute appendicitis to find out its predictive value in complications like perforation. Materials and Methods: This prospective study for diagnostic test evaluation was conducted amongst the inpatients in the Department of General Surgery, KIMSHEALTH Trivandrum, during the period from August 2019 to August 2020. A total number of 100 patients who were admitted with the clinical diagnosis of acute appendicitis were studied, and serum bilirubin and liver function tests were carried out in all of them. Results: Total bilirubin levels when compared with histopathological diagnosis by unpaired samples t-test, the t-value = 0.763, P = 0.447 > 0.05 which shows no statistically significant difference between total bilirubin levels in uncomplicated and complicated acute appendicitis based on histopathological diagnosis. Sensitivity is 81.8%; specificity is 29.2%; positive predictive value (PPV) is 12.5%; negative predictive value (NPV) is 92.9%. Conclusion: Elevated total serum bilirubin levels have a fairly high sensitivity and NPV in predicting complications of acute appendicitis, but the specificity and PPV are quite low, and hence, hyperbilirubinaemia could be used as an aid in diagnosing complicated acute appendicitis along with the clinical findings and ultrasonography findings, but it is not reliable as a standalone diagnostic test. If the total serum bilirubin levels are low, an alternate diagnosis could be suspected, and the chances of complicated appendicitis are quite low, but elevated serum bilirubin values alone cannot confirm the presence of complications. Therefore, our study could not find any correlation between the absolute levels of elevation of total bilirubin values and the presence or absence of complications in acute appendicitis.