Is the LRINEC score useful for predicting necrotizing fasciitis as a complication of MRONJ?
Eiji Iwata1, Junya Kusumoto2, Yuriko Susukida3
1Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan. eiwata@med.kobe-u.ac.jp.
Introduction:
Necrotizing fasciitis as a complication of medication-related osteonecrosis of the jaw (MRONJ), which we named "ONJ-NF", has been sometimes reported. This study aimed to investigate the usefulness of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting ONJ-NF.
Materials And Methods:
We included patients with acute MRONJ who required hospitalization at a single institution from April 2013 to June 2022. They were divided into two groups: patients with ONJ-NF and those with severe cellulitis as a complication of MRONJ, which we named "ONJ-SC." LRINEC scores were compared between the groups and the cut-off value of the score was set by creating a receiver operating characteristic curve.
Results:
Eight patients with ONJ-NF and 22 patients with ONJ-SC were included. The LRINEC score was significantly higher in patients with ONJ-NF (median: 8.0 points, range 6-10 points) than in those with ONJ-SC (median: 2.5 points, range 0-6 points). A LRINEC score of ≥ 6 points had a sensitivity of 100.0%, a specificity of 77.3%, and an area under the curve of 0.97. Among 6 parameters of LRINEC score, only C-reactive protein (CRP) and white blood cell count (WBC) had significant differences between two groups. Most of the patients with ONJ-NF were rescued by antibiotic therapy and surgical drainage including debridement of necrotic tissues, but unfortunately, one patient did not survive.
Conclusion:
Our results suggested that the LRINEC score may be a useful diagnostic tool to predict ONJ-NF but valuating only CRP and WBC may be sufficient particularly in patients with osteoporosis.
Insights
The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score effectively predicts medication-related osteonecrosis of the jaw with necrotizing fasciitis (ONJ-NF). A score of 6 or higher indicates high risk, aiding early diagnosis and treatment of this severe complication.
Area of Science:
- Oral and Maxillofacial Surgery
- Infectious Diseases
- Oncology
Background:
- Medication-related osteonecrosis of the jaw (MRONJ) can lead to severe complications, including necrotizing fasciitis (ONJ-NF).
- Accurate and timely diagnosis of ONJ-NF is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the utility of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in predicting ONJ-NF.
- To compare LRINEC scores between patients with ONJ-NF and severe cellulitis secondary to MRONJ (ONJ-SC).
Main Methods:
- Retrospective analysis of hospitalized patients with acute MRONJ from April 2013 to June 2022.
- Patients were categorized into ONJ-NF and ONJ-SC groups.
- LRINEC scores were calculated and compared; receiver operating characteristic (ROC) curve analysis determined the optimal cut-off value.
Main Results:
- The study included 8 patients with ONJ-NF and 22 with ONJ-SC.
- Patients with ONJ-NF exhibited significantly higher LRINEC scores (median 8.0) compared to ONJ-SC (median 2.5).
- A LRINEC score threshold of ≥6 demonstrated 100.0% sensitivity and 77.3% specificity for ONJ-NF, with an AUC of 0.97. C-reactive protein (CRP) and white blood cell count (WBC) were key differentiating factors.
Conclusions:
- The LRINEC score is a valuable tool for predicting ONJ-NF in MRONJ patients.
- Focusing on CRP and WBC levels within the LRINEC score may be sufficient for diagnosing ONJ-NF, especially in patients with osteoporosis.
