EBQ:LRINEC Score
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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:
Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score[1]
Has not been prospectively validated, index of suspicion is key and 10% of the patients with a score < 6 had Necrotizing Fasciitis. A score > 6 has PPV of 92% and NPV of 96% for necrotizing fasciitis.
- 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 >180 mg/dL (10 mmol/L): 1 point
Grouping by Scores
- Low Risk: score 5 (10% of pts with score < 6 still had nec fasc)
- Moderate Risk: score 6– 7
- High Risk: score >8
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)
Population
Patient Demographics
Inclusion Criteria
Exclusion Criteria
Interventions
Outcomes
Primary Outcome
Secondary Outcomes
Subgroup analysis
Criticisms & Further Discussion
Prior to derivation of the LRINEC score, the admission WBC > 15.4 x 10(9)/L or serum sodium [Na] < 135 mmol/L) was sugested as a method for distinguishing between patients with NF and nonnecrotizing soft tissue infection (non-NF). These two criteria had a PPV 26% and NPV 99%[2]
Funding
none
See Also
Sources
- ↑ 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.
- ↑ Wall DB et al. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000 Sep;191(3):227-31.