Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Abstract

INTRODUCTION Early operative debridement of necrotising fasciitis is a major outcome determinant. Identification and diagnosis of such patients can be clinically difficult. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score first published in 2004 is based on routinely performed parameters and offers a method for identifying early cases. No literature review has yet been performed on the application of such a score. METHODS A systematic review of English-language literature was performed from 2004 to 2014 to identify articles reporting use of LRINEC score and the incidence of necrotising fasciitis. We performed a critical review of PubMed, Medline and Embase in line with the PRISMA statement. A meta-analysis was performed with a random effects model and 95% confidence interval. Suitable correlation coefficient and receiver operating characteristic (ROC) curves were also calculated. RESULTS After application of inclusion criteria, 16 studies with 846 patients were included. The mean LRINEC score in patients with necrotising fasciitis was 6.06. Two papers reported LRINEC score in patients without necrotising fasciitis with a mean 2.45. All six studies with a reported coefficient of variance were < 1; Pearson correlation coefficient was r = 0.637 (P = 0.011). An ROC curve showed an area under the curve of 0.927. CONCLUSIONS The LRINEC score is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotising fasciitis, with a statistically positive correlation between LRINEC score and a true diagnosis of necrotising fasciitis.

Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities

“…The patients in our study were older (median age 68 versus 56), exclusively from the ED, and had higher percentage of diabetes mellitus, peripheral vascular disease, and fever, compared to patients in the study of Wong et al Second, only patients with NF involving the limbs were included in our study, which might have biased the validation results. As previously mentioned, the LRINEC score of NF varied markedly depending on the affected body part, and the limbs had the lowest score of 6, compared to our average LINREC score of 5.3 [26]. Finally, the most common microorganism of monomicrobial necrotizing fasciitis in Europe and Singapore was Group A Streptococcus [5,11,20].…”

“…However, some studies have reported that the LRINEC score is a useful clinical tool with good performance for the diagnosis of NF [16,26]. One report retrospectively validated the LRINEC scores with an AUROC of 0.925, sensitivity of 76.3%, specificity of 93.1%, and positive and negative predictive values of 95.5% and 88.1% based on an LRINEC value of �6 to distinguish NF from severe cellulitis [16].…”

“…The conclusion was that the LRINEC score is a useful and robust scoring system as an adjunct for the early diagnosis of NF. One meta-analysis included 16 studies with 846 patients, and an AUROC of 0.925 was obtained [26]. The study Prospective Validation of the LRINEC Score for Necrotizing Fasciitis of the Extremities revealed that the LRINEC score is a useful clinical determinant in the diagnosis of NF.…”

“…However, in recent validation studies with retrospective chart reviews, the LRINEC score has had inadequate sensitivity in diagnosing NF, ranging from 36 to 83% [5,11,[16][17][18][19][20][21][22][23][24][25]. Furthermore, two systemic reviews of the LRINEC score showed opposite results [14,26]. One study concluded that the LRINEC score is a useful clinical tool in the diagnosis of NF, but the other revealed that the LRINEC score had poor sensitivity of 68.2% with an LRINEC score cutoff �6 and 40.8% with an LRINEC score cutoff �8.…”

“…The LRINEC score varied markedly depending on the affected part of the body, with limbs scoring 6, groin 6.8, and chest/trunk 7.3 [26]. This reflects the fact that patients with NF involving different body parts may have unique characteristics.…”