Case Report of International Journal of Case Reports
Evaluation of laboratory risk indicator for necrotizing fasciitis (Lrinec) scoring system for diagnosis of necrotizing fasciitis in patients presenting with soft tissue infection
Naresh Duthaluri, Adith C, Prabhu P, Rekha A
Sri Ramachandra Medical College,SRIHER
Necrotizing soft tissue infection represents a diverse process; the term itself encompasses a continuum ranging from pyoderma to life threatening infections (clostridial gas gangrene with myonecrosis, anaerobic cellulitis, and severe, necrotizing vibrio infections). These can occur in any anatomical area but the commonest site is the extremities. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. The paucity of specific cutaneous signs to distinguish necrotizing fasciitis from other soft tissue infections such as cellulitis makes the diagnosis extremely difficult. The first and most important consideration for an accurate, prompt diagnosis is to have a high index of suspicion. It has been shown by numerous studies in the past that early recognition and surgical intervention at the earliest is the sole factor in preventing the morbidity and mortality in patients with necrotizing fasciitis [1-3]. So a scoring system which is easy to follow and cost effective with high positive and negative predictive value is required. One such scoring system is the LRINEC scoring system devised by Wong et al  in 2005 which claims to have a positive predictive value of 92.0% and negative predictive value of 96.0%. The mortality in necrotizing fasciitis is as high as 34%.  We evaluated LRINEC scoring system in patients presenting with symptoms and signs suggestive of soft tissue infection that progresses to necrotizing fasciitis in Sri Ramachandra Medical College and Hospital, Porur, Chennai over a period of two years.
Keywords: laboratory risk indicator, necrotizing fasciitis (Lrinec) scoring system, necrotizing fasciitis, soft tissue infection
How to cite this article:
Naresh Duthaluri, Adith C, Prabhu P, Rekha A. Evaluation of laboratory risk indicator for necrotizing fasciitis (Lrinec) scoring system for diagnosis of necrotizing fasciitis in patients presenting with soft tissue infection. International Journal of Case Reports, 2020; 4:155. DOI: 10.28933/ijcr-2020-08-1106
1. Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. AnnSurg 1996; 224: 672e83.
2. Wong C-H, Chang H-C, Pasupathy S, Khin L-W, Tan J-L, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 2003; 85-A:1454e60.
3. McHenry CR, Piotrowski JJ, Petrinic D, et al. Determinants of mortality for necrotizing soft-tissue infections. In: Annals of surgery, 1995; 558e65.
4. Wong CH, Khin LW. The LRINEC (Laboratory Risk indicator for necrotizing fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Critical Care Med 2004;32(7): 1535-1541.
5. David C, Elliot., M.D., Joseph A. Kufera, M.A., and Roy A. M. Myers, M.D, Necrotizing soft tissue infections risk factors for mortality and strategies for management. Annals of surgery, Vol. 224, No. 5, 671-683.
6. Pauline Kha, Julien Colot, Shirley Gervolino, Gilles Guerrier, Necrotizing soft-tissue infections in New Caledonia: Epidemiology, clinical presentation, microbiology, and prognostic factors, Asian Journal of Surgery (2015).
7. N. Shaikh, Ayman El-Menyar, Insolvisagan Natesa Mudali, Hassan Al-Thani, Clinical Presentations and outcomes of necrotizing fasciitis in males and females for a period over 13 years Annals of Medicine and Surgery 4 (2015) 355e360.
8. Chun-I Liao, Yi-Kung Lee, Yung-Cheng Su, Chin-Hsiang Chuang, Chun-Hing Wong, Validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) Score for early diagnosis of necrotizing fasciitis Tzu Chi Medical Journal 24 (2012) 73e76.
This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.