Title: Laboratory Risk Indicator in Necrotizing Fasciitis (LRINEC) Score- An Early Diagnostic Tool for Necrotizing Fasciitis
Author: Dr Snigdh Garg
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.160
Abstract
Objective: To assess the utility of Laboratory Risk Indicator in Necrotizing Fasciitis (LRINEC) Score in cases of Necrotizing Fasciitis as an early diagnostic tool. Necrotizing Fasciitis is a rapidly progressive inflammation of the fascia with secondary necrosis of the subcutaneous tissues. It requires aggressive surgical intervention to combat associated high morbidity and mortality.
Methods: A retrospective analysis of cases admitted in Darbhanga Medical College and Hospital from Sep 2017 to Feb 2019 having diagnosis of Necrotizing Fasciitis at time of admission was done. LRINEC Scoring was done for each of them and confirmation of diagnosis was done by biopsy of tissue samples from the patients. Sensitivity, Specificity, PPV, NPV and Likelihood Ratios were computed for patients taking LRINEC Scores of ≥6 as a cutoff for diagnosis.
Results: Thirty five patients admitted with an initial diagnosis of Necrotizing Fasciitis were eligible for the study. Out of these, fourteen patients had biopsy-proven Necrotizing Fasciitis. Taking LRINEC Score ≥6 as a cutoff, Sensitivity of 85.7%, Specificity of 67%, PPV of 63.2% and NPV of 87.5% for diagnosing Necrotizing Fasciitis was obtained. The Likelihood ratios for a positive and negative biopsy were 2.6 and 0.2 respectively.
Conclusion: LRINEC Score of ≥6 can be used as a cutoff for diagnosis of Necrotizing Fasciitis along with clinical suspicion and using tissue biopsy as a confirmatory test. It should not be used in isolation, as that will lead to a high number of false positives.
Keywords: LRINEC Score, Necrotizing Fasciitis.
