Association between cytokine response, the LRINEC score and outcome in patients with necrotising soft tissue infection: a multicentre, prospective study

Abstract

Early assessment of necrotising soft tissue infection (NSTI) is challenging. Analysis of inflammatory markers could provide important information about disease severity and guide decision making. For this purpose, we investigated the association between cytokine levels and the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC)-score, disease severity and mortality in NSTI patients. In 159 patients, plasma was analysed for IL-1β, IL-6, IL-10 and TNF-α upon admission. The severity of NSTI was assessed by SAPS, SOFA score, septic shock, microbial aetiology, renal replacement therapy and amputation. We found no significant difference in cytokine levels according to a LRINEC- score above or below 6 (IL-1β: 3.0 vs. 1.3; IL-6: 607 vs. 289; IL-10: 38.4 vs. 38.8; TNF-α: 15.1 vs. 7.8 pg/mL, P > 0.05). Patients with β-haemolytic streptococcal infection had higher level of particularly IL-6. There was no difference in mortality between patients with a LRINEC-score above or below 6. In the adjusted analysis assessing 30-day mortality, the association was strongest for IL-1β (OR 3.86 [95% CI, 1.43-10.40], P = 0.008) and IL-10 (4.80 [1.67-13.78], P = 0.004). In conclusion, we found no significant association between the LRINEC-score and cytokine levels on admission. IL-6 was consistently associated with disease severity, whereas IL-1β had the strongest association with 30-day mortality.

SuPAR correlates with mortality and clinical severity in patients with necrotizing soft-tissue infections: results from a prospective, observational cohort study

“…There were no differences in any of the baseline characteristics of this cohort, as published previously by our study group 23 , 24 . Our cohort included an additional 40 patients, as compared to the cohort previously published.…”

Clostridial Gas Gangrene ‐ A Rare but Deadly Infection: Case series and Comparison to Other Necrotizing Soft Tissue Infections

“…Hansen et al found IL-6 to be associated with severity of infection, amputation rate, and mortality, but it had no significant association to the results of LRINEC score 42 . Our data neither showed significant correlation between results of the LRINEC and IL-6 or PCT, nor did we find a correlation between IL-6-level and mortality.…”

Evaluation and Management of Necrotizing Soft Tissue Infections

“…In the original publication, a score of ≥6 yielded a positive predictive value of 92% and negative predictive value of 96%, displaying promise for predicting severity of skin and soft tissue infection among patients presenting to emergency care. Although retrospective validation of this scoring system has been attempted in small case-series 24,25 , a recent multicenter prospective evaluation of the LRINEC score has lessened the excitement around this predictive tool; a cut-off of ≥ or <6 in NSTI patients failed to discriminate between those with and without high cytokine levels, septic shock and death 26 . Furthermore, the LRINEC score can be artificially elevated in other musculoskeletal infections.…”