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Utility of the Laboratory Risk Indicator for Necrotizing Fasciitis Score: Comorbid Conditions Do Matter
Reynold Henry1, Kazuhide Matsushima1, Michael Etzel1
1Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA.
Abstract:
The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) has been proposed as a diagnostic tool for necrotizing soft tissue infection (NSTI). However, its utility remains underreported, particularly in patients with comorbid conditions. The purpose of this study was to identify the test characteristics of LRINEC for patients with various comorbid conditions. We conducted a retrospective study including patients with suspected NSTI. Our study patients were then relegated into the subgroups; intravenous drug use (IVDU), end-stage liver disease (ESLD), and diabetes mellitus (DM). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a positive LRINEC score (≥ 6 or 8) were calculated in reference to intra-operative findings or results of the pathologic examination. Area under the curve (AUC) using receiver operating characteristic (ROC) plots were compared between each subgroup and the overall study population using DeLong test. A total of 220 patients were included for the analysis. Overall, the sensitivity was 76%, specificity of 52%, PPV of 32%, and NPV of 88%. The subgroup analysis showed low PPVs in all subgroups. The DM and ESLD groups had a high NPV (90.5% and 88.0%, respectively), whereas NPV in the IVDU group was 70.6%. The AUC and DeLong test for the subgroups were 0.649 (p = 0.902) for ESLD, 0.699 (p = 0.683) for DM, and 0.565 (p = 0.034) for IVDU. The LRINEC can be a useful adjunct to rule out the diagnosis of NSTI with exception of IVDU. In contrast, further diagnostic workup might be still required in those patients with positive LRINEC.
Insights
The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is useful for ruling out necrotizing soft tissue infection (NSTI), especially in patients with diabetes or liver disease. However, its accuracy is limited in intravenous drug users, requiring further investigation.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Surgical Pathology
Background:
- Necrotizing soft tissue infection (NSTI) diagnosis can be challenging.
- The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a proposed diagnostic tool.
- Limited data exist on LRINEC's utility in patients with comorbid conditions.
Purpose of the Study:
- To evaluate the test characteristics of the LRINEC score in patients with suspected NSTI.
- To assess LRINEC performance across different comorbid conditions: intravenous drug use (IVDU), end-stage liver disease (ESLD), and diabetes mellitus (DM).
Main Methods:
- Retrospective study of 220 patients with suspected NSTI.
- Patients categorized into IVDU, ESLD, and DM subgroups.
- LRINEC score test characteristics (sensitivity, specificity, PPV, NPV) calculated against intra-operative or pathological findings.
- Receiver operating characteristic (ROC) curve analysis and DeLong test used for comparing Area Under the Curve (AUC) between subgroups.
Main Results:
- Overall LRINEC sensitivity was 76%, specificity 52%, PPV 32%, and NPV 88%.
- Subgroup analysis revealed low positive predictive values (PPVs) across all groups.
- High negative predictive values (NPVs) observed for DM (90.5%) and ESLD (88.0%) groups.
- IVDU group showed a lower NPV (70.6%) and a statistically significant AUC difference (p=0.034).
Conclusions:
- The LRINEC score is a valuable tool for excluding NSTI, particularly in patients with DM and ESLD.
- Its utility is limited in IVDU patients, necessitating cautious interpretation and further diagnostic evaluation.
- A positive LRINEC score warrants further investigation, regardless of comorbid status.
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