LRINEC scale in necrotizing fasciitis. A useful diagnostic tool?

• Published in: Revista habanera de ciencias médicas Vol. 17; no. 2; pp. 236 - 243
• Main Authors: Yovanny Ferrer Lozano, Yanett Morejón Trofimova
• Format: Journal Article
• Language: English
• Published: Universidad de Ciencias Médicas de La Habana 01.02.2018

Introduction: The diagnosis of necrotizing fasciitis is very difficult to make, and requires a high degree of clinical suspicion.  Because of the complexity of the diagnosis of this entity, Wong proposed an algorithm based on laboratory parameters in 2004 (LRINEC scale: Laboratory Risk Indicator for Necrotizing Fascitis). Objective: To demonstrate the diagnostic utility of LRINEC scale in necrotizing fasciitis. Material and Method: A descriptive prospective case series study was designed in 28 patients treated in the Department of Orthopedics and Traumatology of the General Teaching Hospital "Julio Arístegui Villamil" with the diagnosis of necrotizing fasciitis, from January 2000 to June 2015.  LRINEC (Laboratory Risk Indicator for Necrotizing Fascitis) score is calculated to predict risk of the disease. Results:LRINEC score showed an intermediate risk stratification (6-7). In the patients that survived, lower C-reactive protein levels than the ones in the deceased patients were found (t=9,7).  The patients who were included in the study and died presented lower levels of hemoglobin than the ones who survived (t=8,5), and higher values of creatinine (t=5,5).  The average value of leukocytes recount in both groups was below 15x109 cels/µl. The area under the ROC curve was 0,607 (IC95%=0,47-0,73) for the LRINEC Score in this study. The cutoff point had a sensitivity of 66% and a specificity of 75%. Conclusions: LRINEC scale is a useful tool when a necrotizing fasciitis is suspected, but additional information is usually required to confirm the diagnosis.   Keywords: necrotizing fasciitis, LRINEC scale, risk of disease, diagnostic algorithm.