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Journal articles on the topic 'Laboratory Risk Indicator For Necrotising Fasciitis'

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Published: 5 June 2025

Last updated: 16 July 2025

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Bechar, J., S. Sepehripour, J. Hardwicke, and G. Filobbos. "Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature." Annals of The Royal College of Surgeons of England 99, no. 5 (2017): 341–46. http://dx.doi.org/10.1308/rcsann.2017.0053.

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Introduction Early operative debridement of necrotising fasciitis is a major outcome determinant. Identification and diagnosis of such patients can be clinically difficult. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score first published in 2004 is based on routinely performed parameters and offers a method for identifying early cases. No literature review has yet been performed on the application of such a score. Methods A systematic review of English-language literature was performed from 2004 to 2014 to identify articles reporting use of LRINEC score and the incidence of necrotising fasciitis. We performed a critical review of PubMed, Medline and Embase in line with the PRISMA statement. A meta-analysis was performed with a random effects model and 95% confidence interval. Suitable correlation coefficient and receiver operating characteristic (ROC) curves were also calculated. Results After application of inclusion criteria, 16 studies with 846 patients were included. The mean LRINEC score in patients with necrotising fasciitis was 6.06. Two papers reported LRINEC score in patients without necrotising fasciitis with a mean 2.45. All six studies with a reported coefficient of variance were < 1; Pearson correlation coefficient was r = 0.637 (P = 0.011). An ROC curve showed an area under the curve of 0.927. Conclusions The LRINEC score is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotising fasciitis, with a statistically positive correlation between LRINEC score and a true diagnosis of necrotising fasciitis.

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Holland, M. J. "Application of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) Score to Patients in a Tropical Tertiary Referral Centre." Anaesthesia and Intensive Care 37, no. 4 (2009): 588–92. http://dx.doi.org/10.1177/0310057x0903700416.

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The objective of this study was to assess the applicability and usefulness of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score in patients from our institution. A retrospective analysis was undertaken of the case notes of all patients admitted to our facility between January 2002 and December 2005 with the admission diagnosis of necrotising fasciitis and the application of the LRINEC score upon the initial blood tests. The sensitivity, specificity and likelihood ratios were then calculated for patients with a LRINEC score of ≥6 compared with the findings of a surgical biopsy. Twenty-eight patients were identified as having the admission diagnosis of necrotising fasciitis on the hospital database and were eligible for the study. Ten of these had biopsy-proven necrotising fasciitis. With a cut-off score of ≥6, the LRINEC score had a sensitivity of 80%, specificity of 67%, a positive predictive value of 57% and a negative predictive value of 86% in distinguishing the patients with proven necrotising fasciitis from those with severe soft tissue infections. The likelihood ratio of a positive biopsy was 2.4 and the likelihood ratio of a negative biopsy was 0.3. A cut-off value of ≥6 of the LRINEC score was not overly sensitive or specific, and the likelihood ratios suggest that, at this cut-off level, the LRINEC score would have only a very small effect on the post-test probability of the patients in the studied population having necrotising fasciitis.

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Damisa, Josiah, Sohail Ahmed, and Sanjay Harrison. "Necrotising fasciitis: a narrative review of the literature." British Journal of Hospital Medicine 82, no. 4 (2021): 1–9. http://dx.doi.org/10.12968/hmed.2020.0577.

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Necrotising fasciitis is a severe, life-threatening and rapidly progressive soft tissue infection that often requires aggressive surgical management, with an estimated incidence of about 0.24–0.40 per 100 000 in the UK. Necrotising fasciitis can be classified based on its microbiology or the anatomy or body region affected. Initial signs of necrotising fasciitis can be minimal and non-specific but a patient often presents with pain out of proportion to clinical signs on examination, as well as erythema and oedema, in addition to systemic symptoms associated with sepsis. Diagnosis is often based on high clinical suspicion with biochemical and clinical imaging used as adjuncts. To aid with early diagnosis of necrotising fasciitis, a scoring system known as the Laboratory Risk Indicator for necrotising fasciitis was developed which has a positive predictive value of 92%. Once diagnosed, appropriate resuscitation and antibiotics, along with prompt and aggressive surgical debridement, is the mainstay of treatment.

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Abdullah, Muhammad, Billy McWilliams, and Saad U. Khan. "Reliability of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score." Surgeon 17, no. 5 (2019): 309–18. http://dx.doi.org/10.1016/j.surge.2018.08.001.

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REDDY, Raghunatha, Purushothaman RANGASWAMY, Preetham RAJ, Chandrakant KESARI, and Ganesh SAGAR. "Laboratory risk indicator for necrotising fasciitis [LRINEC] score as a tool for differentiating necrotising fasciitis from other soft tissue infections." Journal of Experimental and Clinical Medicine 38, no. 4 (2021): 571–76. http://dx.doi.org/10.52142/omujecm.38.4.31.

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Swain, RA, JC Hatcher, BS Azadian, N. Soni, and B. De Souza. "A five-year review of necrotising fasciitis in a tertiary referral unit." Annals of The Royal College of Surgeons of England 95, no. 1 (2013): 57–60. http://dx.doi.org/10.1308/003588413x13511609956093.

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Introduction Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of necrotising fasciitis admitted to a tertiary referral unit and to assess the validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system. Methods A retrospective analysis of patient notes over the five-year period from October 2006 to October 2011 was undertaken. The LRINEC score was calculated for each patient to evaluate its usefulness. Results Overall, 15 patients were diagnosed with necrotising fasciitis. Three patients died. The median age of patients was 51.0 years (range: 34–76 years). There were no obvious predisposing factors in 8 cases but patients had a median of 2.0 co-morbidities. The most common infective agent, present in five patients, was Group A Streptococcus. Other monomicrobial agents included Group G Streptococcus and Klebsiella pneumoniae. Polymicrobial infections were less common than monomicrobial infections and two patients had a polymicrobial infection including methicillin-resistant Staphylococcus aureus. Although the LRINEC scoring system identified 12 of the 15 patients as having a high or intermediate likelihood of necrotising fasciitis, 3 were classified as low likelihood. Conclusions This limited case series strongly suggests that the LRINEC system is too insensitive for diagnosis.

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A, Syed, Alvin T, Fazrina A, and Abdul R. "Determining if Positive Predictive Value using Laboratory Risk Indicator for Necrotising Fasciitis is Applicable in Malaysian Patients with Necrotising Fasciitis." Malaysian Orthopaedic Journal 11, no. 2 (2017): 36–39. http://dx.doi.org/10.5704/moj.1707.005.

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Solis, Edgardo, Yi Liang, Grahame Ctercteko, and James Wei Tatt Toh. "Dangers of delayed diagnosis of perianal abscess and undrained perianal sepsis in Fournier’s gangrene: a case series." BMJ Case Reports 13, no. 10 (2020): e236503. http://dx.doi.org/10.1136/bcr-2020-236503.

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Fournier’s gangrene (FG) is a rapidly progressing infective necrotising fasciitis of the perianal, perineal and genital region. It is characterised by its aggressive nature and high mortality rates of between 15% and 50%. While it has been commonly found to primarily develop from urological sources, there have been increasing reports of the role of colorectal sources as the underlying aetiology of FG. Presented is a case series of four FG presentations at a single institution during a 12-month period as a result of underlying untreated perianal disease highlighting its dangers in progressing to a deadly infection, advocating for early and aggressive surgical debridement, and the role of adjunct scoring systems, such as Laboratory Risk Indicator for Necrotising Fasciitis, in guiding clinical diagnosis.

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Neilly, DW, M. Smith, A. Woo, V. Bateman, and I. Stevenson. "Necrotising fasciitis in the North East of Scotland: a 10-year retrospective review." Annals of The Royal College of Surgeons of England 101, no. 5 (2019): 363–72. http://dx.doi.org/10.1308/rcsann.2019.0013.

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Introduction Necrotising fasciitis is a life-threatening rapidly progressing bacterial infection of the skin requiring prompt diagnosis and treatment. Optimum care warrants a combination of surgical debridement, antibiotics and intensive care support. All cases of necrotising fasciitis in 10 years in the North East of Scotland were reviewed to investigate and improve patient care. Methods Cases between August 2006 and February 2016 were reviewed using case notes and electronic hospital records. Data including mode of admission, clinical observations, investigations, operative interventions, microbiological and clinical outcomes was collected and reviewed. Analysis required multidisciplinary input including microbiology, infectious disease, trauma and orthopaedics, plastic surgery and intensive care teams. Results A total of 36 cases were identified. The mean laboratory risk indicator for necrotising fasciitis (LRINEC) score was 7 and 86% of patients fulfilled the criteria for necrotising fasciitis. Patients were commonly haemodynamically stable upon admission but deteriorated rapidly; 36% of patients had a temperature of over 37.5 degrees C on initial observations; 29/36 patients were discharged, 6 patients died acutely (acute mortality rate of 17%); 18/31 of cases were polymicrobial with Streptococcus pyogenes, the common organism. Six amputations or disarticulations were performed from a total of 82 operations in this group, with radical debridement the usual primary operation. The mean time to theatre was 3.54 hours. Highly elevated admission respiratory rate (50 breaths/minute) was associated with increased mortality. Conclusions Necrotising fasciitis presents subtly and carries significant morbidity and mortality. A high index of suspicion allows early diagnosis and intervention. We believe that a pan-specialty approach is the cornerstone for good outcomes.

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Tupkar, Gopi, and Mohammed Imran Khaleel. "THE LABORATORY RISK INDICATOR FOR NECROTISING FASCIITIS (LRINEC) SCORINGTHE DIAGNOSTIC AND POTENTIAL PROGNOSTIC ROLE." Journal of Evidence Based Medicine and Healthcare 4, no. 87 (2017): 5078–81. http://dx.doi.org/10.18410/jebmh/2017/1015.

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S., Sudhir, and Rachit Arora. "Use of serum lactate and serum sodium at admission to predict mortality in necrotising fasciitis." International Surgery Journal 5, no. 12 (2018): 4040. http://dx.doi.org/10.18203/2349-2902.isj20185041.

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Background: The term necrotizing fasciitis (NF) describes a group of life-threatening infections of the skin, soft tissues, and muscles, which tend to progress rapidly through the fascia planes, causing gradual destruction of the fascia. The mortality rate for NF remains high and has not changed significantly for several decades. The prognosis depends on accurate diagnosis and immediate institution of appropriate treatment.The current difficulty in initial diagnosis is due to the lack of obvious skin findings early on in the infection. Laboratory tests, including the laboratory risk indicator for necrotizing fasciitis, gas on imaging tests, and physical exam findings.Methods: This is a prospective study of 100 patients of necrotising fasciitis. Serum sodium and serum lactate at time of admission were used to predict mortality.Results: Total of 21 patients died. Above Serum lactate value of 2.95mmol/l mortality rate was 48.3%. and below it was 9.9%. Serum sodium was non significant in predicting mortality.Conclusions: The mortality of NF remains high. A simple model using serum lactate at time of admission may help identify patients at greatest risk of death.

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Daniels, Marc, Walter Perbix, Henrik Oberländer, Jennifer Schiefer, Paul Christian Fuchs, and Harun Seyhan. "The performance of clinical risk scores in the diagnosis of necrotising fasciitis." Journal of Wound Care 32, no. 5 (2023): 284–90. http://dx.doi.org/10.12968/jowc.2023.32.5.284.

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Objective: Necrotising fasciitis (NF) is a quickly progressing and potentially life-threatening infection, involving the fascia and subcutaneous tissues. The diagnosis of this disease is challenging, especially due to a lack of specific clinical signs. In order to ensure a better and quicker identification of NF patients, a laboratory risk indicator score has been developed for NF (LRINEC). A variant has widened this score by adding clinical parameters (modified LRINEC). This study shows current outcomes of NF and compares the two scoring systems. Methods: This study was conducted between 2011 and 2018, and included patient demographics, clinical presentations, sites of infection, comorbidities, microbiological and laboratory findings, antibiotic therapies and LRINEC as well as modified LRINEC scores. The primary outcome was in-hospital mortality. Results: A cohort of 36 patients, diagnosed with NF, were included in this study. The mean hospital stay was 56 days (±38.2 days). The mortality rate in the cohort was 25%. The sensitivity of the LRINEC score was 86%. Calculation of the modified LRINEC score showed an improvement of the sensitivity to 97%. The average LRINEC score and modified LRINEC score for patients who died and who survived were equal (7.4 versus 7.9 and 10.4 versus 10.0, respectively). Conclusion: The mortality rate of NF remains high. The modified LRINEC score increased the sensitivity in our cohort to 97%, and this scoring system could be supportive in the diagnosis of NF for early surgical debridement.

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Nagendra, Rajsamant, Kanta Tripathy Nalini, Kalyan Mishra Devi, and Ranjan Nayak Deepak. "To Evaluate Influence of Clinical Features, LRINEC Scoring System, Imaging and Microbiological Flora on the Outcome of Patients with NSTI." International Journal of Toxicological and Pharmacological Research 13, no. 4 (2023): 84–92. https://doi.org/10.5281/zenodo.11215816.

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Introduction: Skin and/or subcutaneous tissue infections are highly diverse with regard to etiology, causative organisms, incidence, clinical features, severity and complications. Necrotising Soft Tissue Infection (NSTI) is a rapidly progressive infection primarily involving the fascia and the subcutaneous tissue. NSTI encompasses necrotising form of cellulitis, fasciitis and myositis depending of the depth of tissue involved. Specific terms are also used when specific sites are involved, such as Fournier’s gangrene for genitourinary tract, Meleney’s ulcer for anterior abdominal wall and Ludwig’s angina for submandibular and sublingual spaces. Aims: To study the influence of clinical features, LRINEC Scoring System, Imaging and Microbiological flora on the outcome of patients with NSTI. Materials and Methods: This prospective observational study was undertaken taking all the patients admitted to the Department of Surgery, SCB Medical College, Cuttack from Nov 2018 to Oct 2020 with a provisional diagnosis of severe skin and soft tissue infection with high degree of suspicion for NSTI as study population. The Skin includes Epidermis and Dermis. The Epidermis consists of five layers. stratum corneum (keratin layer) stratum lucidum (present in soles and palms only) stratum granulosum (granular cell layer) stratum spinosum (prickle cell layer) and stratum basale (keratin layer). Epidermis contains no blood vessels so cells there derive nourishment by diffusion. The venous drainage of the skin is via both valved and unvalved veins. Unvalved veins allow oscillating flow in the subdermal plexus between cutaneous territories, equilibrating flow and pressure. The valved cutaneous veins drain via plexi to the deep veins. Conclusion: NSTI are often fatal, characterized by extensive necrosis of the fascia and subcutaneous tissues. It is perhaps the most severe form of soft tissue infection potentially limb and life threatening. Early diagnosis of necrotizing fasciitis is essential to advocate timely management for the better wellbeing of the patient. LRINEC scoring system has a better positive predictive value in identifying the onset of necrotizing fasciitis and risk strategizing of the patients with severe soft tissue infections.

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Al-Hindawi, Ahmed, James McGhee, Joseph Lockey, and Marcela Vizcaychipi. "Validation of the laboratory risk indicator for necrotising fasciitis scoring system (LRINEC) in a Northern European population." Journal of Plastic, Reconstructive & Aesthetic Surgery 70, no. 1 (2017): 141–43. http://dx.doi.org/10.1016/j.bjps.2016.05.014.

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Rahman, A., A. K. Abou-Foul, A. Yusaf, J. Holton, and L. Cogswell. "Necrotising Myositis, the Deadly Impersonator." Case Reports in Surgery 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/485651.

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We report two cases of patients with necrotising myositis who presented initially with limb pain and swelling on a background of respiratory complaints. Patient 1, a previously well 38-year-old female, underwent various investigations in the emergency department for excessive lower limb pain and a skin rash. Patient 2, a 61-year-old female with a background of rheumatoid arthritis and hypertension, presented to accident and emergency feeling generally unwell and was treated for presumed respiratory sepsis. Both deteriorated rapidly and were referred to the plastic surgery team with soft tissue necrosis, impending multiorgan failure and toxaemia. Large areas of necrotic muscle and skin were debrided, which grew group A streptococci,Streptococcus pyogenes. Patient 1 had a high above knee amputation of the left leg with extensive debridement of the right. Despite aggressive surgical intervention and microbiological input with intensive care support, patient 2 died. These two cases highlight the importance of early diagnosis and prompt surgical and pharmacological intervention in managing this life-threatening disease. Pain is the primary symptom with skin changes being a late and subtle sign in a septic patient. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) may be of use if there is concern to aid diagnosis of this life-threatening disease.

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V., Vijayalakshmi, Sabari Girieasen M., Deepika S., Kannan R., and M. S. Kalyan Kumar. "Multimodal management of Fournier’s gangrene with subsequent wound closure techniques." International Surgery Journal 9, no. 2 (2022): 459. http://dx.doi.org/10.18203/2349-2902.isj20220342.

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Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scrotum, urinary diversion and penoscrotal split skin grafting, delayed primary closure (with and without orchidectomy) and wound healing by secondary intention.

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Rao, Battalapalli Sri Hari, Mallikarjuna Pavan, Y. Mutheeswaraiah, et al. "A comparative study of necrotising fasciitis in patients with and without type 2 diabetes mellitus." Journal of Clinical and Scientific Research 13, no. 3 (2024): 170–77. http://dx.doi.org/10.4103/jcsr.jcsr_73_23.

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Abstract Background: Sparse published data are available comparing necrotising fasciitis (NF) in patients with and without type 2 diabetes mellitus (T2DM). Methods: Consecutive patients presenting with NF to our tertiary care teaching institute in Tirupati from March 2021 to June 2022 (n = 100; with T2DM [n = 60], without T2DM [n = 40]) were prospectively studied. The predisposing factors, clinical presentation, performance of laboratory risk indicator for necrotising fasciitis (LRINEC) score and its association with inhospital outcome of NF were compared in patients with and without T2DM. Results: In NF patients with or without T2DM, mean age (58.3 ± 11.0 Vs 55.3 ± 15.5 years; P = 0.22), gender distribution (M: F = 42:18 Vs 29:11; P = 0.787), history of trauma (50% Vs 45%; P = 0.787) and site of involvement (right lower limb 45% Vs. 35%; P = 0.813) were similar. A significantly higher proportion of patients with T2DM had chronic kidney disease (6/60 Vs 11/40; P = 0.02) and corticosteroid use (8/60 Vs 4/40; P = 0.04) compared to those without T2DM. The mean LRINEC score was similar in patients with and without T2DM (7.3 ± 2.5 Vs 6.8 ± 3.0; P = 0.9). The mean duration of intensive care unit stay (days) (4.4 ± 4.0 Vs 3.3 ± 2.4; P = 0.12), amputation rates (13.3% Vs 10%; P = 0.615) and mortality (25% Vs 22.5%; P = 0.774) were similar in NF patients with and without T2DM. Conclusions: Our observations suggest that predisposing factors, clinical presentation and outcomes were similar in NF patients with and without T2DM.

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Ravindhran, Bharadhwaj, Sendhil Rajan, Deepshika Kerketta, Gayatri Balachandran, and Lakshmeshwar Nagaraj Mohan. "Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Versus Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) as Predictors of Outcome in Necrotising Fasciitis." Indian Journal of Surgery 82, no. 3 (2019): 325–30. http://dx.doi.org/10.1007/s12262-019-01929-w.

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Glass, GE, F. Sheil, JC Ruston, and PEM Butler. "Necrotising soft tissue infection in a UK metropolitan population." Annals of The Royal College of Surgeons of England 97, no. 1 (2015): 46–51. http://dx.doi.org/10.1308/003588414x14055925058553.

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Introduction Necrotising soft tissue infection (NSTI) is a rare but life threatening diagnosis. Geographic, economic and social variances influence presentation and prognosis. As the current literature does not reflect a UK metropolitan population, we conducted a retrospective chart review to establish pertinent features relevant to our practice. Methods Patients with histologically confirmed diagnoses of NSTI presenting to two London teaching hospitals between January 2007 and July 2013 were included in the study. Features of presentation, surgical and medical management, microbiological findings and outcome were evaluated. Results Twenty-four patients with histologically confirmed NSTI were included. Two age clusters were identified, with means of 46 years (standard deviation [SD]: 10 years) and 80 years (SD: 6 years). Pain, erythema and sepsis were common findings. Hypertension, hypercholesterolaemia and type II diabetes mellitus were common co-morbidities. A third of younger patients had human immunodeficiency virus or hepatitis C, with a quarter dependent on drugs and/or alcohol. The mean Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was 5.8 (SD: 3.3). The lower extremities, groin and perineum were common sites of infection. Fourteen patients required inotropic support and seventeen required transfusions. The median number of surgical procedures was 5 (range: 1–17). Group A Streptococcus was the most frequently identified pathogen. Five patients died. Being elderly, female sex and failure to use clindamycin as a first-line antibiotic were associated with significantly higher mortality. Conclusions In contrast to other recent series, group A streptococcal monomicrobial NSTI remains the most common presentation in our population. Survival is anticipated in young patients, regardless of premorbid status. Elderly patients have a poor prognosis. The negative predictive value of the LRINEC score is questioned. Use of clindamycin as a first-line antibiotic is supported.

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Ture, Zeynep, Gamze Kalin Unuvar, Aliye Esmaoglu, Aysegul Ulu-Kilic, Atilla Coruh, and Mehmet Doganay. "Severe and complicated soft tissue infections: a single-centre case series." Journal of Wound Care 32, no. 8 (2023): 492–99. http://dx.doi.org/10.12968/jowc.2023.32.8.492.

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Objective: To assess the demographic and clinical characteristics, laboratory findings, and economic burden of patients with a diagnosis of complicated skin and soft tissue infection (cSSTI). Method: The demographic and clinical characteristics, laboratory findings, surgical interventions, cost of treatment, and outcome of patients diagnosed with cSSTIs between January 2017 and December 2019 were retrospectively analysed. Results: A total of 24 patients with cSSTIs were included in the study. The median age was 53 (22–85) years, and 14 (58%) were female. The most common comorbidity was diabetes (54%). On admission, 75% of patients presented with sepsis, and 70% had a high-grade Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score. The causative microorganism was isolated from 21 (87%) patients, and the multidrug resistance rate of Gram-negative bacteria was 50%. The median number of debridements was 3 (1–12). In all, 11 patients were followed up in the intensive care unit, and the mortality rate was 29%. The presence of confusion (p=0.025), causative Gram-negative microorganisms (p=0.009), hyponatraemia (p=0.034), the need for intensive care (p=0.001), anti-meticillin-resistant Staphylococcus aureus antibiotics (p=0.023) and the rate of antibiotic changes during treatment (p=0.019) were significantly higher in the non-survival patient group. Hyponatraemia was a significant independent risk factor for mortality (p=0.048). The median cost of per-patient treatment was $9453 USD in the non-surviving and $1536 in the surviving group. Conclusion: It is important to know possible factors and local resistance rates at the beginning of empirical antibacterial and surgical treatment. The presence of hyponatraemia, sepsis and a high LRINEC score can be considered to be the mortality predictors.

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Maitra, Tapash Kumar, Mahmud Ekramullah, Nilufar Shabnam, Sharmistha Roy, and Samiran Kumar Mondol. "Clinical & Microbiological profile of Fourniers Gangrene in a Tertiary Care Hospital in Bangladesh : A prospective observational study." Bangladesh Critical Care Journal 5, no. 1 (2017): 28–32. http://dx.doi.org/10.3329/bccj.v5i1.32539.

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Background: Fourniers gangrene is the necrotising fasciitis of the genitalia and perineum, with associated poly microbial infection. Evidence based data in the very recent years suggest that it is associated with significant and potential risk of organ failure or death.Aim: This study was designed to be conducted among the patients suffering from Fourniers gangrene with a view to assess the probable prevalence rate of potentially adverse clinical consequences during course of treatment, overall mortality and to observe the microbiological pattern in our surgical practice.Method & materials: This cross sectional study was conducted among the 69 patients of Fourniers gangrene in BIRDEM General Hospital, Dhaka, Bangladesh from Jan 10.2013 to Sept 01 .2016, using the purposive sampling method.Results: The results of this study reflects that majority (43.4%) of the study population were in 51 to 60 years age group( Mean age 43±1.7 years) in study population. By using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, it was found that in most of the patients (approx 56.5%), a suspicious score ranging 06-08 was observed and only in 10.1% patients, a specific score of ?08 was observed. In 27.5% patients systemic complications like DIC, ARDS, MODS, MSOF and severe sepsis were observed in 1.4%, 4.3%, 10.1%, 4.3% and 5.7% cases respectively. Mortality rate was approximately 4.3%. Majority (84.1%) of the patients were associated with type 1 (Polymicrobial) bacterial infection, whereas in case of 15.9% patients, it was associated with type 2 (Monomicrobial) infection. Escherichia coli was the most frequently observed micro-organisms associated with approximately 39.1% of all cases. S. aureus, Staphylococcus pyogenes, Enterococci species, E.coli and Pseudomonas species were recorded to be associated with 17.4%, 27.5%, 21.7%, 39.1 and 10.1% cases respectively.Conclusion: This study suggests that Fourniers gangrene is associated with significant systemic complications. Poly microbial infections are most predominant and E coli infection was commonest organism involved.Bangladesh Crit Care J March 2017; 5(1): 28-32

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ÇOLAK, Sabri, and Beril GÜRLEK. "Are neutrophil count and neutrophil/lymphocyte ratio useful as markers of polycystic ovary syndrome in early reproductive age?" Journal of Experimental and Clinical Medicine 38, no. 4 (2021): 577–82. http://dx.doi.org/10.52142/omujecm.38.4.32.

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Necrotizing fasciitis (NF) is often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The present study was aimed to validate the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score as a tool to predict/diagnose NF and to differentiate it from other soft tissue infections depending on the score. A Prospective Observational study was conducted in ESICMC PGI MSR, Medical College Hospital, Rajajinagar, Bengaluru, from Jan 2019 to June 2020. Patients ≥18 years of age with severe soft tissue infections were included in the study. Based on the LRINEC score, the patients were categorised as low (≤5), moderate (6-7) and high risk (≥8) for the prediction of onset or diagnosis of NF. Data analysis was performed using SPSS version 21.0. A total of 55 patients were included in the study. A significant 3 association was observed with age (p=0.042), LRINEC score (p=0.0001), C Reactive Protein (CRP; p=0.0001), haemoglobin (p=0.008), serum Department of XXX, University of XXX, XXX Training and Research Hospital, City, Country sodium levels (p=0.004), serum creatinine (0.001), and amputation (p=0.004). Amputation was done in 5 cases. Only 1 mortality was observed 4Department of XXX, Faculty of XXX, City, Country in LRINEC high risk group with NSSTI. To conclude, LRINEC scoring system showed a better positive predictive value in identifying the onset of NF and risk strategizing of the patients with severe soft tissue infections. This study has aimed to contribute to the literature by investigating the value of inflammatory biomarkers of polycystic ovary syndrome (PCOS) that can be tested via a complete blood count. This retrospectively designed case-control study included 197 women in early reproductive age; who were in the age range of 18-24 years and who were admitted to the gynecology outpatient clinic. A total of 111 PCOS patients; in whom the diagnosis of PCOS was made based on Rotterdam criteria, were included in the study. A control group was formed by including 86 healthy women. All measurements of inflammatory biomarkers were obtained from the complete blood count test results. Of the inflammatory markers; the neutrophil count and the neutrophil/lymphocyte ratio were statistically significantly higher in the PCOS group compared to the control group (p=0.016 and p=0.002, respectively); however, the measured values of other parameters were similar between two groups. To evaluate whether or not the neutrophil count and neutrophil/lymphocyte ratio could be used as a screening tool to exclude PCOS, we constructed a receiver-operating characteristic curve (ROC). The ROC curve for the neutrophil count was 0.60 (p=0.016) and NLR was 0.627 (p=0.002). The neutrophil count and NLR were higher in the PCOS cases compared to the age-matched individuals in the control group. This finding confirms the presence of inflammation in PCOS cases of early reproductive age. However, it has been demonstrated that the diagnostic values of these markers are not strong in distinguishing PCOS patients from healthy individuals.

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Rajendran, Kathiravan. "Clinical profile and outcome of the patients with necrotising fasciitis in a tertiary care teaching hospital at rural Puducherry, India." IP Journal of Surgery and Allied Sciences 3, no. 4 (2022): 101–6. http://dx.doi.org/10.18231/j.jsas.2021.023.

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Necrotising fasciitis is rapidly progressive inflammation with infection and secondary necrosis. The incidence of it is increasing recent times. The challenge associated with its treatment is identification of the process at an earlier stage to improve outcome and reduce the dreadful complications. To study the socio-demographic, clinical, microbiological, risk factor profile and complications of patients diagnosed with necrotizing fasciitis. It was a cross sectional descriptive study carried out in surgery ward of a tertiary care teaching hospital. Patients diagnosed with necrotising fasciitis were included in the study. After detailed clinical and laboratory evaluation appropriate surgical and medical interventions were administered and were followed to note the outcome. Epi Info software version 3.5.3 was used for data entry and statistical analysis. 82% of the study participants were more than 40 years old and 76% of them were males. All of them had fever, pain and tenderness, 76% of them had swelling and 50% of them had foul smelling discharge. The commonest site involved was lower extremity (36%). Diabetes mellitus as a predisposing factor was found in 52%. 84% of the infections were polymicrobial and E. coli was isolated from 74% among them. 34 % had developed complications during hospital stay. Though it is a dreadful infectious condition prompt recognition decreases morbidity and mortality. The risk factors identified, complications occurred needs to be given importance to improve treatment outcome among patients admitted with necrotising fasciitis.

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Ling, XW, K. Lin, XQ Jiang, et al. "International normalised ratio as an independent predictor of mortality in limb necrotising fasciitis with sepsis." Annals of The Royal College of Surgeons of England 103, no. 1 (2021): 35–40. http://dx.doi.org/10.1308/rcsann.2020.0189.

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Introduction Necrotising fasciitis with sepsis is a life threatening disease. The aim of this study was to analyse the association between international normalised ratio (INR) and mortality in sepsis patients with necrotising fasciitis. Methods A retrospective review was undertaken of 106 patients suffering from necrotising fasciitis with sepsis between November 2007 and December 2016. Data on comorbidities, clinical manifestations, laboratory findings, causative microbiological organisms, APACHE II (Acute Physiology and Chronic Health Evaluation II) score and outcomes were extracted. Logistic regression was carried out to examine the factors affecting mortality. Results Forty patients (37.7%) died. There was no significant difference in the white blood count (WBC) for the survivor and non-survivor groups. Non-survivors had a lower mean oxygenation index (OI) (288.7mmHg vs 329.4mmHg, p=0.032) and platelet count (PC) (139.5 vs 214.8 x 109/l, p=0.028), and a higher mean INR (1.9 vs 1.3, p=0.000), activated partial thromboplastin time (APTT) (54.6 vs 44.2 seconds, p=0.005) and serum creatinine (2.3mg/dl vs 1.4mg/dl, p=0.007). Mortality in patients with INR >1.5 was significantly higher than in those with INR <1.5 when all risk factors (WBC, PC, OI, INR, APTT, creatinine) were considered (odds ratio: 4.414, 95% confidence interval: 1.263–15.428, p=0.020). Even after adjusting for age, sex, bacteraemia, diabetes and hepatic disorders, the data still exhibited elevated mortality for patients with INR >1.5 (odds ratio: 5.600, 95% confidence interval: 1.415–22.166, p=0.014). Conclusions INR is a significant independent predictor of mortality in sepsis patients diagnosed with necrotising fasciitis.

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Soitkar, Angir, Murtaza Akhtar, Abhay Choudhari, and Satish Deshmukh. "Necrotizing fasciitis: diagnostic and prognostic value of laboratory risk indicator for necrotizing fasciitis score." International Surgery Journal 6, no. 5 (2019): 1750. http://dx.doi.org/10.18203/2349-2902.isj20191901.

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Background: Necrotizing fasciitis (NF) is a potentially life threatening disease. Delayed recognition and surgical intervention is directly linked to increased mortality. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score, a laboratory oriented tool has potential to prevent morbidity and mortality but there exhibits a controversy regarding its utility which needs re-evaluation to prove it’s utility.Methods: A tertiary care hospital based observational study aims to evaluate diagnostic and prognostic value of LRINEC score. Patient above 18 years clinically diagnosed as SSTI and confirmed as NF histopathologically without co-morbidities were enrolled as subjects. Clinical evaluation and laboratory oriented LRINEC score were the study factors. Outcome factors were morbidity and mortality and histopathological confirmation of NF. Patients were analyzed as cellulitis and NF with identification of factors associated with NF; Univariate analysis with Kaplan-Meier survival analysis and ROC plotting was done.Results: Total 166 patients were enrolled with mean age of 47.14±15.76 years and 2:1 is the male : female ratio and. A total of 117 patients were diagnosed as Cellulitis and 49 patients were NF. Clinically Discharge, fever and cuticular necrosis was statistically associated with NF (p<0.01). Mortality in NF was 22.4% and no mortality in Cellulitis. Mean LRINEC score in cellulitis and NF was 1.95±0.972 and 7.57±1.51 (p<0.01). Survival analysis graph and ROC showed LRINEC score of 6 as diagnostic and score ≥9 as poor prognostic indicator.Conclusions: LRINEC score is a useful diagnostic and prognostic tool in patients of NF.

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Fujinaga, Jun, Akira Kuriyama, Tetsunori Ikegami, and Mutsuo Onodera. "Laboratory risk indicator for necrotizing fasciitis score and patient outcomes." Journal of Emergencies, Trauma, and Shock 14, no. 1 (2021): 38. http://dx.doi.org/10.4103/jets.jets_17_20.

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Su, Yi-Chun, Hung-Wen Chen, Yu-Cheng Hong, Chih-Tsung Chen, Cheng-Ting Hsiao, and I.-Chuan Chen. "LABORATORY RISK INDICATOR FOR NECROTIZING FASCIITIS SCORE AND THE OUTCOMES." ANZ Journal of Surgery 78, no. 11 (2008): 968–72. http://dx.doi.org/10.1111/j.1445-2197.2008.04713.x.

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Sato, Eleanor H., and Christopher M. Domes. "Classifications in Brief: Laboratory Risk Indicator for Necrotizing Fasciitis Score." Clinical Orthopaedics & Related Research 478, no. 9 (2020): 2180–83. http://dx.doi.org/10.1097/corr.0000000000001291.

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Faizal Ansari, Mohd, Sukhwinder Singh, R. K Verma, and A. V Mathur. "Laboratory Risk Indicator for Necrotizing Fasciitis Score and their Outcomes." International Journal of Science and Research (IJSR) 12, no. 12 (2023): 585–90. http://dx.doi.org/10.21275/sr231205190940.

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Narsingh, Narendra Prasad, Anjana Nigam, and Ramesh Kumar. "A study on role of laboratory risk indicator for necrotizing fasciitis score in necrotizing fasciitis." International Surgery Journal 6, no. 11 (2019): 3901. http://dx.doi.org/10.18203/2349-2902.isj20194575.

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Background: Necrotizing fasciitis (NF) represents a group of highly lethal infection characterized by rapidly progressing inflammation and necrosis. The spectrum of disease ranges from necrosis of the skin to life threatening infection. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score is only scoring system available so far to help us towards making an early and accurate diagnosis.Methods: The current prospective observational study was conducted in the Surgery OPD and emergency, Department of surgery, Dr. B.R. Ambedkar Memorial Hospital, Raipur, CG, India, during study period October 2017 to September 2018. Sample size was fixed at 100. Blood tests taken on admission were used to calculate the LRINEC score in each case.Results: In this study 55% of patients with soft tissue infections were categorized as low risk for progression of NF. Necrotizing soft tissue infection (NSTI) occurs in all age groups, ranging from 18 to 75 years. Clinical findings of crepitus were found in 33% of all patients of NSTI. 96% of the patients underwent debridement once, debridement was done twice in 3% of the patients while debridement was not done in 1% of the patients who belonged to high risk group and had no comorbidities. Out of 100, 3 patients underwent amputation. We found that there is mortality rate of 5%.Conclusions: NF was most severe form of soft tissue infection, potentially life and limb threatening. Early diagnosis of NF is essential for early management and better prognosis of patients.

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Narasimhan, Vignesh, Geraldine Ooi, Stephanie Weidlich, and Phillip Carson. "Laboratory Risk Indicator for Necrotizing Fasciitis score for early diagnosis of necrotizing fasciitis in Darwin." ANZ Journal of Surgery 88, no. 1-2 (2017): E45—E49. http://dx.doi.org/10.1111/ans.13895.

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Chowdary, Murakonda Sowmya, Srinivasan D., Sreeramulu P. N., Tejaswini M. Pawar, and Krishna Prasad K. "The clinical efficacy of laboratory risk indicator for necrotizing fascitis score in early diagnosis of patients with necrotizing fascitis." International Surgery Journal 8, no. 7 (2021): 2133. http://dx.doi.org/10.18203/2349-2902.isj20212721.

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Background: Necrotizing fasciitis is a rare, rapidly progressive infection which causes extensive necrosis of the fascia and subcutaneous tissue. Early recognition and debridement are major prognostic determinants, and delay has been shown to increase mortality rate. We describe a novel, simple, and objective scoring system, the laboratory risk indicator for necrotizing fasciitis (LRINEC) score, based on routine laboratory investigations readily available at most centres, that can help to distinguish necrotizing fasciitis (nec fasc) from severe cellulitis or abscess.Methods: We performed a single centre, retrospective, all patients treated at the RLJ Hospital for necrotizing fasciitis between January 2017 and December 2019 were included in this study. The outcome of the study was based on comparing LRINEC score and Wang and Wong staging, which is useful to detect necrotizing fasciitis severity.Results: In our study, males were predominantly affected more common in lower limbs followed by perineum and abdominal wall in their fifties with diabetes mellitus and hypertension as dominant co-morbid diseases. In the study among subjects with high risk score, 83.3% required ICU stay, among subjects with moderate risk, 16.7% required ICU stay and among subjects with low risk, 12.5% required ICU stay.Conclusions: All patients with higher LRINEC scores and who were classified as ‘high risk’ in Wang and Wong classification required ICU stay and significant association with mortality rate.

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Inchingolo, Alessio Danilo, Sabino Ceci, Luisa Limongelli, et al. "Cavernous Sinus Involvement and Near Miss Mediastinitis following Mandibular Tooth Infection Treated during the COVID-19 Pandemic: Clinical Diagnosis and Treatment." Case Reports in Dentistry 2022 (July 12, 2022): 1–13. http://dx.doi.org/10.1155/2022/8650099.

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Odontogenic infections represent a frequent condition that in some cases, if not treated promptly, can spread quickly to the rest of the body and turn into life-threatening infections. In this work, the case is reported of a 59-year-old woman, diabetic and overweight, who presented to the Odontostomatology and Otolaryngology Section of the Policlinic of Bari with mandibular tooth infection that had developed into a deep neck space infection leading to the involvement of cavernous sinuses and near mediastinum. The diagnosis, the surgical drainage of the phlegmon and removal of infection foci, appropriate control of the airways, and a correct antibiotic therapy made it possible to avoid a potentially fatal condition. Prompt management and early diagnosis of deep space neck infections, such as phlegmon and/or necrotizing fasciitis, with the auxilium of CT scans and tools such as LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis), NLR (Neutrophil-to-Lymphocyte Ratio), and LRINECxNLR scores (Laboratory Risk Indicator for Necrotizing Fasciitis and Neutrophil to Lymphocyte Ratio), are advised to evade delays and complications that could potentially worsen the patient’s outcome.

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Papa, Nathan, and Renishka Sellayah. "Re: Laboratory Risk Indicator for Necrotizing Fasciitis score for early diagnosis of necrotizing fasciitis in Darwin." ANZ Journal of Surgery 87, no. 12 (2017): 1061. http://dx.doi.org/10.1111/ans.14200.

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Saad, Syed, Panchami P., and Gulamnabi . "Laboratory risk indicator for necrotizing fasciitis: an objective scoring system as a tool for early diagnosis of necrotizing fasciitis." International Surgery Journal 9, no. 1 (2021): 102. http://dx.doi.org/10.18203/2349-2902.isj20215139.

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Background: Necrotizing soft tissue infections are often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The mortality of 30-40% reflects the inadequacy of early recognition of necrotizing soft tissue infections. This study emphasizes on the search for a tool that reliably and rapidly identifies patients with NF. An objective of current study was to validate the LRINEC score as a tool for early distinguishing of necrotizing fasciitis from other soft tissue infections.Methods: Prospective clinical study analysis of outcome of sixty of patients with soft tissue infections were evaluated based on LRINEC. Based on their LRINEC score, the patients were categorized as low, intermediate and high risk for the onset of necrotizing fasciitis.Results: A total of 60 patients with soft tissue infections were prospectively evaluated and categorized on the basis of LRINEC score 45 patients in low risk category, 7 in Intermediate risk and 8 patients in high risk group. In terms of outcome, all cases (including positive tissue diagnosis cases) in low risk and intermediate risk groups and 2 cases in high risk group were improved with surgical debridement/fasciotomy. The cutoff of LRINEC ≥6 has better sensitivity and specificity in identifying the risk of the patient.Conclusions: LRINEC scoring system has a better positive predictive value in identifying the onset and risk strategizing of necrotizing fasciitis.

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M, Martis Manohar H., Prathvi Shetty, and Hegde B. R. "Reliability of the Laboratory Risk Indicator for Necrotizing Fasciitis (Lrinec) Score for Early Diagnosis of Necrotizing Fasciitis." Journal of Diagnostics 2, no. 2 (2015): 10–17. http://dx.doi.org/10.18488/journal.98/2015.2.2/98.2.10.17.

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Liao, Chun-I., Yi-Kung Lee, Yung-Cheng Su, Chin-Hsiang Chuang, and 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, no. 2 (2012): 73–76. http://dx.doi.org/10.1016/j.tcmj.2012.02.009.

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Kumar, Neeraj, Raghav Garg, Rajesh Kumar Soni, and Ratnakar Namdeo. "Correlation of the laboratory risk indicators for necrotizing fasciitis (LRINEC) score with the clinical features and surgical management of necrotizing soft tissue infections." International Surgery Journal 5, no. 10 (2018): 3394. http://dx.doi.org/10.18203/2349-2902.isj20184096.

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Background: Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to correlate the clinical features of NSTI with the LRINEC score, its application to distinguish Necrotizing Fasciitis (NF) from other non NSTI and its utility in early surgical management of NSTI.Methods: Patients were evaluated for various symptoms and signs at the time of admission and certain laboratory parameters were assessed. LRINEC score was then calculated. Correlation of the management and severity of infections with respective LRINEC score was then found out.Results: LRINEC score for predicting conservative management of NSTI has a sensitivity of 81.8% and specificity of 98% while for predicting amputation and mortality shows a sensitivity of 100% and specificity of 84.5%.Conclusions: The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis.

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Kumar, Sumit, Suhas Agarwal, Gaurav Patel, Ishan Sehgal, Sandeep Gara, and Pushkar Yadav. "Efficacy of LRINEC Scoring in Patients of Necrotizing Fasciitis and its Correlation with the Outcome." Polish Journal of Surgery 96, no. 2 (2024): 1–5. http://dx.doi.org/10.5604/01.3001.0053.9502.

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ABSTRACTBackground: Necrotizing fasciitis is an expeditiously escalating inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. To aid diagnosis, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was devised to stratify the likelihood of infection in patients on presentation. Objectives: Study aimed to investigate and quantify the relationships between the LRINEC scoring system and the outcomes such as need for amputation, length of hospital and mortality stay in patients with necrotizing fasciitis. Method: A total number of 90 Patients were admitted with a provisional diagnosis of necrotizing fasciitis. LRINEC score was calculated for each case based on six laboratory variables at the time of presentation. Enrolled patients were divided into three groups on the basis of LRINEC score. The differences in mortality, length of hospitalization, number of debridement and the need of amputation between these groups were compared. Results: Increasing age, male gender, DM has a poor prognosis in the outcome of necrotizing fasciitis patients. The amputation rates and mortality rates are better correlated with higher LRINEC score. Conclusion: The LRINEC score helps in stratifying the patients into risk categories such as low risk, moderate risk and high risk categories, according to severity in a much organized way and the appropriate management like surgical debridement can be started timely. LRINEC score is a robust index that is capable of detecting early cases of necrotizing fasciitis and is simple enough for routine use. It is a simplified bedside diagnostic tool for early diagnosis and prediction of outcome in patients of necrotizing fasciitis.

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Riaz Shahid, Muhammad, Usman Ghani, Muhammad Ayub Ashraf, Fahd Rashid, Muhammad Shahid, and Fahim Khattak. "To assess the diagnostic accuracy of LRINEC Score for prediction of necrotizing fasciitis in patients presenting with clinical skin and subcutaneous tissue infections." Infectious Diseases Journal of Pakistan 33, no. 2 (2024): 74–78. http://dx.doi.org/10.61529/idjp.v33i2.313.

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Background: Necrotizing fasciitis is an inflammatory disease that causes the skin, soft tissues, and fascia to break down. A strain of Streptococcus pyogenes bacteria is frequently the source of it, however mixed infections involving coliforms, anaerobes, and Gram-negative bacteria can also be to blame. Even with contemporary medical care, necrotizing fasciitis is associated with a significant fatality rate. The objective of this study is to determine the diagnostic accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting necrotizing fasciitis in patients with cutaneous and subcutaneous tissue infections. Material and Methods: This Cross-sectional study was conducted at Combined Military Hospital, Rawalpindi from May 2021 to October 2022. Hundred cases of probable necrotizing fasciitis coupled with clinical cutaneous or subcutaneous infections were included. They underwent clinical examinations and blood investigation (Sodium, Hemoglobin, total white cell count, Glucose, Creatinine, C-reactive protein (CRP), and biopsy for histopathology). Patients under the age of 15 or older than 75, with soft-tissue infections, undergone surgical debridement and without the result of CRP in the initial 48 hours of retention were excluded. LRINEC score ≥6 was used for labelling a case with necrotizing fasciitis. LRINEC score was then compared with results of histopathology and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using SPSS version 23. Results: 35 (35%) out of total belonged to the age group between 46-55 years. Male and female ratio were 64 (64%) and 36 (36%). Diabetes mellitus was the most common etiological cause occurring in 56 (56%) patients. The sensitivity of the LRINEC scoring system was 79.7% and the specificity noted was 87.8%. The PPV was 90.4% and the NPV came out to be 75%. Conclusions: LRINEC scoring system has a significant sensitivity and reasonable specificity in diagnosing cases of Necrotizing fasciitis among patients with severe soft-tissue infection. LRINEC score can be used for predicting the outcome of such cases. Keywords: Laboratory risk indicator for necrotizing fasciitis (LRINEC), Necrotizing fasciitis, Subcutaneous tissue infections

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Djajakusumah, Teguh Marfen, Rani Septrina, and Arief Dwinanda. "Accuracy of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score System as An Early Diagnostic Predictor of Necrotizing Fasciitis in A Tertiary Referral Hospital in Bandung, Indonesia." Althea Medical Journal 11, no. 3 (2024): 188–95. https://doi.org/10.15850/amj.v11n3.3341.

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Background: Necrotizing fasciitis (NF) is a serious infection that can rapidly kill tissue and potentially lead to multiple organ failure. Early diagnosis and treatment are essential for survival. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score may aid in early detection of NF. Although initially promising, studies on the effectiveness of LRINEC have shown mixed results. This study aimed to investigate the accuracy of LRINEC in predicting NF. Methods: This was an observational prospective cohort study, including patients with NF as well as skin and soft tissue infection (SSTI) who were treated at a tertiary referral hospital in Bandung, Indonesia in 2022. The LRINEC scores was calculated to measure sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The accuracy of LRINEC scores was specified in the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results: Of the total 70 patients, 33 were diagnosed with NF and 37 with SSTI. The LRINEC score with ≥6 points cut-off showed a sensitivity of 90.9% (95%CI; 75.67–98.08%), specificity of 75.60% (95%CI; 58.80–88.23%), PPV of 76.9% (95%CI; 60.67–88.87%), and NPV 90.30% (95%CI; 74.25–97.96%). The area under the ROC (AUROC) curve for the accuracy of the LRINEC scores was 0.895 (95%CI; 0.821–0.969). Conclusions: The laboratory risk indicator for necrotizing fasciitis (LRINEC) score is an accurate predictor and feasible early diagnostic indicator in NF. However, clinical judgment remains a crucial factor in diagnosing NF.

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Gonullu, Dogan, Ahmet Serkan Ilgun, Okan Demiray, et al. "The Potential Prognostic Significance of the Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) Score in Necrotizing Fasciitis." Chirurgia 114, no. 3 (2019): 376. http://dx.doi.org/10.21614/chirurgia.114.3.376.

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Wong, Chin-Ho, and Lay-Wai Khin. "Clinical Relevance of the LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) Score for Assessment of Early Necrotizing Fasciitis." Critical Care Medicine 33, no. 7 (2005): 1677. http://dx.doi.org/10.1097/01.ccm.0000170199.43624.b8.

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Narasimhan, Vignesh, Geraldine Ooi, Stephanie Weidlich, and Phillip Carson. "Response to Re: Laboratory Risk Indicator for Necrotizing Fasciitis score for early diagnosis of necrotizing fasciitis in Darwin." ANZ Journal of Surgery 87, no. 12 (2017): 1062. http://dx.doi.org/10.1111/ans.14228.

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Chao, Wai-Nang, Shih-Jei Tsai, Chin-Feng Tsai, et al. "The Laboratory Risk Indicator for Necrotizing Fasciitis score for discernment of necrotizing fasciitis originated from Vibrio vulnificus infections." Journal of Trauma and Acute Care Surgery 73, no. 6 (2012): 1576–82. http://dx.doi.org/10.1097/ta.0b013e318270d761.

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Sandner, Annett, Stefan Moritz, Susanne Unverzagt, Stefan K. Plontke, and Dietrich Metz. "Cervical Necrotizing Fasciitis—The Value of the Laboratory Risk Indicator for Necrotizing Fasciitis Score as an Indicative Parameter." Journal of Oral and Maxillofacial Surgery 73, no. 12 (2015): 2319–33. http://dx.doi.org/10.1016/j.joms.2015.05.035.

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Hsiao, Cheng-Ting, Chia-Peng Chang, Tsung-Yu Huang, Yi-Chuan Chen, and Wen-Chih Fann. "Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities." PLOS ONE 15, no. 1 (2020): e0227748. http://dx.doi.org/10.1371/journal.pone.0227748.

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Hoesl, Vanessa, Sally Kempa, Lukas Prantl, et al. "The LRINEC Score—An Indicator for the Course and Prognosis of Necrotizing Fasciitis?" Journal of Clinical Medicine 11, no. 13 (2022): 3583. http://dx.doi.org/10.3390/jcm11133583.

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Background: The Laboratory Risk Indicator for Necrotizing Fasciitis score (LRINEC) is a simple tool used to support early diagnosis of Necrotizing Fasciitis (NF). The aim of this study was to investigate whether the LRINEC is suitable as a progression and prognosis parameter in patients with NF. Methods: In this retrospective study, laboratory data of 70 patients with NF were analyzed. The LRINEC was calculated for every patient at the time of hospital admission and postoperatively after surgical interventions. Furthermore, the LRINEC was examined as a prognostic factor for survival. Results: The overall lethality of our series was 20 out of 70 (28.6%). A highly significant LRINEC decrease was found for serial debridements. The largest decrease was observed after the first debridement. There was a significant difference between the initial LRINEC of deceased and surviving patients. A cut off value of >6.5 (7 LRINEC points) resulted in an optimal constellation of sensitivity (70%) and specificity (60%) to predict lethality in patients with NF. Conclusions: The LRINEC significantly decreases after surgical debridement. An initial LRINEC equal or greater than seven is an independent prognostic marker for lethality and can help to identify high-risk patients.

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Hsiao, Cheng-Ting, Chia-Peng Chang, Tsung-Yu Huang, Yi-Chuan Chen, and Wen-Chih Fann. "Correction: Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities." PLOS ONE 17, no. 6 (2022): e0270726. http://dx.doi.org/10.1371/journal.pone.0270726.

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Suraphee, Sujitta, Piyapatr Busababodhin, Rapeeporn Chamchong, Pinyo Suparatanachatpun, and Khemmanant Khamthong. "Modified Laboratory Risk Indicator and Machine Learning in Classifying Necrotizing Fasciitis from Cellulitis Patients." Applied Sciences 14, no. 20 (2024): 9241. http://dx.doi.org/10.3390/app14209241.

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Abstract:

Necrotizing fasciitis (NF) is a severe and life-threatening soft tissue infection that requires timely and accurate diagnosis to improve patient outcomes. The early diagnosis of NF remains challenging due to its similarity to other subcutaneous soft tissue infections like cellulitis. This study aims to employ machine learning techniques to differentiate NF from cellulitis and enhance the diagnostic accuracy of NF by developing a modified LRINEC (MLRINEC) score. These modifications aimed to improve the sensitivity and specificity of NF diagnosis. The study utilized three machine learning classifiers—Logistic Regression, decision tree, and Random Forest—to assess their effectiveness in distinguishing between NF and cellulitis cases. The MLRINEC score was developed by incorporating six key blood test parameters: creatinine, hemoglobin, platelet count, sodium, white blood cell count, and C-reactive protein using laboratory data from Maha Sarakham Hospital in Northeastern Thailand. Our findings indicate that the decision tree classifier demonstrated superior performance, achieving the highest recall, particularly in accurately identifying NF cases. A feature importance analysis revealed that hemoglobin levels and white blood cell counts were the most critical factors influencing the model’s predictions. The platelet count (PT), C-reactive protein (CRP), and creatinine (CT) also played important roles, while sodium levels (NA) were the least influential. The MLRINEC score demonstrates high accuracy in classifying NF and cellulitis patients, paving the way for improved diagnostic protocols in clinical settings.

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