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Published on: November 30, 2021
Modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) Score System in Diagnosing Necrotizing
Haotian Wu1,2, Song Liu1,2, Chunxia Li3
1Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
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.
Insights
A modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) score effectively distinguishes necrotizing fasciitis (NF) from other infections. An m-LRINEC score above 17 suggests a high likelihood of NF, aiding early diagnosis.
Area of Science:
- Medical diagnostics
- Infectious disease research
- Surgical pathology
Background:
- Necrotizing fasciitis (NF) is a severe soft-tissue infection requiring prompt diagnosis and treatment.
- Accurate differentiation of NF from other severe soft-tissue infections is crucial for appropriate management.
- Existing diagnostic tools may have limitations in discriminating NF effectively.
Purpose of the Study:
- To develop and validate a modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) scoring system.
- To assess the m-LRINEC system's ability to differentiate NF from other severe soft-tissue infections.
- To improve diagnostic accuracy for NF.
Main Methods:
- A case-control study involving 177 patients (59 with NF, 118 with other infections) from January 2014 to December 2020.
- Development of the m-LRINEC by incorporating diabetes and kidney disease comorbidities, using high-sensitivity C-reactive protein (HCRP), and redefining cut-off values.
- Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were employed for model development and evaluation.
Main Results:
- The m-LRINEC system was developed by adding diabetes and kidney disease, substituting CRP with HCRP, and adjusting cut-offs.
- The optimal m-LRINEC cut-off score was determined to be 17 points.
- The m-LRINEC demonstrated high diagnostic performance with a sensitivity of 93.2%, specificity of 86.9%, and an Area Under the Curve (AUC) of 0.935.
Conclusions:
- The m-LRINEC scoring system is a sensitive and specific tool for differentiating NF from other severe soft-tissue infections.
- An m-LRINEC score exceeding 17 warrants a high clinical suspicion for NF.
- Further validation in larger, well-designed studies is recommended to confirm the m-LRINEC's utility.
