Reliability of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score

Abdullah, Muhammad; McWilliams, Billy; Khan, Saad Ullah

doi:10.1016/j.surge.2018.08.001

Cited by 43 publications

(41 citation statements)

References 26 publications

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“…However, recent studies on the LRINEC may have reported overpraised results. In different settings, the sensitivity of the LRIN EC was 43.2-80.0% for a score of ≥ 6 and 28.6-68.4% for a score of ≥ 8 [10][11][12]. Furthermore, some studies have shown the LRINEC to be non-relevant [11,13].…”

Section: Et Al Developed the Laboratory Riskmentioning

confidence: 99%

Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections

Hsiao

et al. 2021

World J Emerg Surg

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Background We conducted this study to promote a modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score and evaluate the utility in distinguishing necrotizing fasciitis (NF) from other soft-tissue infections. Method A retrospective cohort study of hospitalized patients with NF diagnosed by surgical finding was conducted in two tertiary hospital in southern Taiwan between January 2015 and January 2020. Another group was matched by controls with non-necrotizing soft tissue infections based on time, demographics, and immune status. Data such as infectious location, comorbidities, and laboratory findings were recorded and compared. Logistics regression were used to determine the association with NF after adjustment for confounders and MLRINEC score was developed by then. Receiver operating curve (ROC) and the area under the curve (AUC) were used to evaluate its discriminating ability. Result A total of 303 patients were included; 101 in NF group and 202 in non-NF group. We added serum lactate and comorbid liver disease to the original LRINEC score and re-defined the cut-off values for 3 variables to develop the MLRINEC score. The cut-off value for MLRINEC score was 12 points with corresponding sensitivity of 91.8% and a specificity of 88.4%, and the area under ROC (AUC) was 0.893 (95% CI, 0.723 to 0.948; p < 0.01). Conclusion MLRINEC score shows a high sensitivity and specificity in distinguishing NF from non-necrotizing soft-tissue infections. Patients with a MLRINEC score > 12 points should be highly suspected of presence of necrotizing fasciitis.

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Section: Et Al Developed the Laboratory Riskmentioning

confidence: 99%

Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections

Hsiao

et al. 2021

World J Emerg Surg

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“…The standard score has a maximum of 13 points. A result higher than 8 points categorizes patients as "high risk" for a necrotizing infection [26][27][28] .…”

Section: Laboratory Risk Indicator For Necrotizing Fasciitismentioning

confidence: 99%

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

Leiblein

Wagner

Adam

et al. 2020

Orthopaedic Surgery

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Objective: Clostridial gas gangrene (GG) or clostridial myonecrosis is a very rare but life-threatening necrotizing soft tissue infection (NSTI) caused by anaerobic, spore-forming, and gas-producing clostridium subspecies. It is the most rapidly spreading and lethal infection in humans, also affecting muscle tissue. The high mortality, of up to 100%, in clostridial GG is mediated by potent bacterial exotoxins. Necrotizing fasciitis (NF) is an important differential diagnosis, most often caused by group A streptococci, primarily not affecting musculature but the subcutaneous tissue and fascia. In the early stages of the infection, it is difficult to distinguish between GG and NF. Therefore, we compare both infection types, identify relevant differences in initial clinical presentation and later course, and present the results of our patients in a retrospective review. Methods: Patients diagnosed with GG from 2008 to 2018 in our level one trauma center were identified. Their charts were reviewed retrospectively and data analyzed in terms of demographic information, microbiological and histological results, therapeutic course, outcome, and mortality rates. The laboratory risk indicator for NF (LRINEC) score was applied on the first blood work acquired. Results were compared to those of a second group diagnosed with NF. Results: Five patients with GG and nine patients with NF were included in the present study. Patients with GG had a mortality rate of 80% compared to 0% in patients with NF. In eight patients with NF, affected limbs could be salvaged; one NF underwent amputation. LRINEC did not show significant differences between the groups; however, C-reactive protein was significantly increased (P = 0.009) and hemoglobin (Hb) was significantly decreased (P = 0.02) in patients with GG. Interleukin-6 and procalcitonin levels did not show significant difference. Patients with GG were older (70.2 vs 50 years). Of the isolated bacteria, 86% were sensitive to the initial calculated antibiotic treatment with ampicillin-sulbactam or imipenem plus metronidazole plus clindamycin. Conclusion: Both GG and NF need full-scale surgical, antibiotic, and intensive care treatment, especially within the first days. Among patients with NSTI, those with clostridial GG have a significantly increased mortality risk due to early septic shock caused by clostridial toxins. In the initial stages, clinical differences are hardly detectable. Immediate surgical debridement is the key to successful therapy for NSTI and needs to be performed as early as possible. However, patients should be treated in a center with an experienced interdisciplinary intensive care team based on a predetermined treatment plan.

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“…In 2004, Wong et al 7 developed the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system, and demonstrated its high sensitivity in both development and validation cohorts (for ≥6 points, 89.9% and 92.9%, respectively) in discriminating NF from other severe soft-tissue infections. However, in the ensuing validity studies, researchers found that the validity of the LRINEC had been overstated, and its sensitivity was 43.2-80.0% for a score of ≥6 and 28.6-68.4% for a score of ≥8 in different settings, countries or regions; 1,[8][9][10] some studies even demonstrated it to be nonspecific. 9,11 However, in other studies, the authors suggested that LRINEC had high sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) Score System in Diagnosing Necrotizing Fasciitis: A Nested Case–Control Study

Wu¹,

Liu²,

Li³

et al. 2021

IDR

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Aim This study aims to present a modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) scoring system and to evaluate its ability in discriminating necrotizing fasciitis (NF) from other severe soft-tissue infections. Methods Patients with NF diagnosed by surgical findings in our institution between January 2014 and December 2020 were included as the case group, matched by controls with severe soft-tissue infections other than NF in a ratio of 2:1, based on demographics, calendar time and immunosuppressant status. Patients’ demographics, comorbidities and laboratory test results were extracted from medical records. Logistic regression analyses were used to determine the association with NF after adjustment for confounders, whereby m-LRINEC was developed. Receiver operating characteristics (ROC) curves and the area under the curve (AUC) were used to evaluate its discriminating ability. Results There were 177 patients included, 59 in the NF group and 118 in the non-NF group. We added comorbid diabetes and kidney disease to the original LRINEC scoring system, used high-sensitivity C-reactive protein (HCRP) to replace the CRP and redefined the cut-off values for the other four variables, to develop the m-LRINEC system. The cut-off value for m-LRINEC was 17 points, with corresponding sensitivity of 93.2% and specificity of 86.9%, and the AUC was 0.935 (95% CI 0.892 to 0.977; p <0.001). Conclusion The m-LRINEC scoring system shows a high sensitivity and specificity in discriminating NF from other severe soft-tissue infections. Patients with an m-LRINEC score of >17 points should have a high index of suspicion for the presence of NF. The validity of the m-LRINEC needs to be confirmed in studies with larger samples and better design.

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Reliability of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score

Cited by 43 publications

References 26 publications

Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections

Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections

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

Modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) Score System in Diagnosing Necrotizing Fasciitis: A Nested Case–Control Study

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