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Determining if Positive Predictive Value using Laboratory Risk Indicator for Necrotising Fasciitis is Applicable in
1Department of Orthopaedics, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia.
Abstract:
Introduction: Necrotising fasciitis (NF) is a rapidly progressive infection of the subcutaneous tissue and fascia which spreads rapidly. The scoring system of Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) developed by Wong et al has been proposed as a tool for distinguishing NF and other soft tissue infections (STI) in Singapore. We set out to establish whether the LRINEC score is applicable in our Malaysian setting. Materials and Methods: A cross sectional study of all patients admitted to our hospital diagnosed with NF or To Rule Out NF (TRO NF) between January 1st 2016 to 30th June 2016. The sensitivity, specificity, positive and negative predictive values were then calculated for LRINEC score of ≥ 6 and ≥ 8. Results: Fourty-four patients were identified with the diagnosis of NF or TRO NF in the study. Twenty-seven patients (61.4%) were deemed post-operatively as having NF and 17 patients (38.6%) not having NF. A sensitivity of 59.3% and specificity of 47.1% when a LRINEC score of ≥ 6 was taken with positive predictive value (PPV) of 64.0% and the negative predictive value (NPV) of 42.1%. When score ≥ 8 was taken, the sensitivity was 48.1% and specificity of 58.8% with PPV of 65% and NPV of 41.7%. Conclusion: The low sensitivity and low PPV achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections.
Insights
The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score is not a reliable tool for differentiating necrotising fasciitis from other soft tissue infections in Malaysia. This study found low sensitivity and predictive values, indicating its unsuitability for sole diagnostic use.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Diagnostic Accuracy
Background:
- Necrotising fasciitis (NF) is a severe, rapidly progressing soft tissue infection.
- The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was developed to aid in distinguishing NF from other soft tissue infections (STI).
- The applicability of the LRINEC score in diverse clinical settings, such as Malaysia, requires validation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the LRINEC score in a Malaysian population.
- To determine the sensitivity, specificity, and predictive values of the LRINEC score for identifying necrotising fasciitis.
Main Methods:
- A cross-sectional study was conducted on patients admitted with suspected or confirmed necrotising fasciitis.
- The LRINEC score was calculated for each patient.
- Diagnostic performance metrics were assessed for LRINEC score thresholds of ≥ 6 and ≥ 8.
Main Results:
- Of 44 patients, 27 (61.4%) had confirmed NF.
- A LRINEC score ≥ 6 showed 59.3% sensitivity and 47.1% specificity (PPV 64.0%, NPV 42.1%).
- A LRINEC score ≥ 8 showed 48.1% sensitivity and 58.8% specificity (PPV 65%, NPV 41.7%).
Conclusions:
- The LRINEC score demonstrated low sensitivity and low positive predictive values in this Malaysian cohort.
- These findings suggest the LRINEC score is not suitable as a standalone diagnostic tool for necrotising fasciitis.
- Further research may be needed to identify more effective diagnostic markers for NF.
