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Necrotizing Fasciitis – LRINEC Score

March 11, 2017

On the Shoulders of Giants

Worst mnemonic ever
This score is great, but the mnemonic could use some work.  A LRINEC score of >/=6 had very high diagnostic accuracy for identifying cases of necrotizing fasciitis (PPV 92%; NPV 96%).  The score consists of common laboratory studies we routinely order.  See this great tool from MDCalc.  A subsequent validation study (hat tip to MDCalc for the reference) showed the diagnostic accuracy was not as good as this original paper.  Word to the wise – you can have a LRINEC score of zero and necrotizing fasciitis, so clinical judgment trumps all scoring systems.

For fun, I propose we change the name to NEC-FAST – NECrotizing Fasciitis Assessment of Serum Testing.  That’s pretty bad – but better than LRINEC – honestly, what’s a LRINEC?

Spoon Feed
The LRINEC (aka NEC-FAST) score is a highly accurate way to help distinguish ordinary skin infections from necrotizing fasciitis.  Getting the diagnosis early means more rapid debridement and a better chance at surviving the illness.  WikEM has a great in-depth review of this article




Abstract

Crit Care Med. 2004 Jul;32(7):1535-41.

The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections.

Wong CH1, Khin LW, Heng KS, Tan KC, Low CO.

Author information:

1Department of Plastic Surgery, Singapore General Hospital, Singapore.

Comment in

Abstract

OBJECTIVE:

Early operative debridement is a major determinant of outcome in necrotizing fasciitis. However, early recognition is difficult clinically. We aimed to develop a novel diagnostic scoring system for distinguishing necrotizing fasciitis from other soft tissue infections based on laboratory tests routinely performed for the evaluation of severe soft tissue infections: the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score.

DESIGN:

Retrospective observational study of patients divided into a developmental cohort (n = 314) and validation cohort (n = 140)

SETTING:

Two teaching tertiary care hospitals.

PATIENTS:

One hundred forty-five patients with necrotizing fasciitis and 309 patients with severe cellulitis or abscesses admitted to the participating hospitals.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The developmental cohort consisted of 89 consecutive patients admitted for necrotizing fasciitis. Control patients (n = 225) were randomly selected from patients admitted with severe cellulitis or abscesses during the same period. Hematologic and biochemical results done on admission were converted into categorical variables for analysis. Univariate and multivariate logistic regression was used to select significant predictors. Total white cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein were selected. The LRINEC score was constructed by converting into integer the regression coefficients of independently predictive factors in the multiple logistic regression model for diagnosing necrotizing fasciitis. The cutoff value for the LRINEC score was 6 points with a positive predictive value of 92.0% and negative predictive value of 96.0%. Model performance was very good (Hosmer-Lemeshow statistic, p =.910); area under the receiver operating characteristic curve was 0.980 and 0.976 in the developmental and validation cohorts, respectively.

CONCLUSIONS:

The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis. The variables used are routinely measured to assess severe soft tissue infections. Patients with a LRINEC score of > or = 6 should be carefully evaluated for the presence of necrotizing fasciitis.

PMID: 15241098 [PubMed – indexed for MEDLINE]

What are your thoughts?