EBQ:LRINEC Score

Under Review Journal Club Article

Wong C. "The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections". Crit Care Med. 2004. 32(7):1535-41.
PubMed Full text PDF

Clinical Question

• Is it possible to develop a diagnostic scoring system to distinguish necrotizing fasciitis (NF) from other soft tissue infections based on laboratory tests routinely performed for the evaluation of severe soft tissue infections?
• Developed the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score to aid in the to risk stratification of patients presenting with signs of cellulitis in order determine likelihoood of NF.

Conclusion

• The LRINEC score may help in detecting cases of necrotizing fasciitis, even early in the disease course. The variables used in the score are routinely measured to assess severe soft tissue infections. Patients with LRINEC score ≥ 6 should be careful evaluated for the presence of necrotizing fasciitis.

Major Points

Using six laboratory measurements a Score greater than or equal to 6 indicates that necrotizing fasciitis should be considered high on the differential diagnosis. The LRINEC Scoring system is:

• CRP (mg/L) ≥150: 4 points
• WBC count (×10³/mm³)
  • <15: 0 points
  • 15–25: 1 point
  • >25: 2 points
• Hemoglobin (g/dL)
  • >13.5: 0 points
  • 11–13.5: 1 point
  • <11: 2 points
• Sodium (mmol/L) <135: 2 points
• Creatinine (umol/L) >141: 2 points
• Glucose (mmol/L) >10: 1 point

A LRINEC score, a score ≥ 6 is a reasonable cut-off to rule in necrotizing fasciitis, but a LRINEC < 6 does not completely rule out the diagnosis.

Study Design

• Retrospective observational study, two teaching tertiary care hospitals
• Patients divided into a developmental cohort (N=314) and a validation cohort (N=140)

Funding

none