Narasimhan Vignesh, Ooi Geraldine, Weidlich Stephanie, Carson Phillip
Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Department of General Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2018 Jan;88(1-2):E45-E49. doi: 10.1111/ans.13895. Epub 2017 Mar 15.
Soft tissue infections are a major health burden in the Top End of the Northern Territory of Australia. Necrotizing fasciitis (NF) is associated with mortality rates from 8 to 40%. Early recognition and aggressive surgical debridement are the cornerstones of successful treatment. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, developed by Wong et al., uses six routine biochemical variables to aid early diagnosis. We aim to assess the diagnostic efficacy of the LRINEC score in our population.
A retrospective review of patients with NF between 2005 and 2013 was conducted. A time matched cohort of abscesses/cellulitis was selected. Admission bloods were used to calculate the LRINEC score. An intraoperative finding of NF was used as the gold standard definition for comparison. The diagnostic accuracy of the LRINEC score was assessed.
Ninety-eight patients with NF and 205 control patients were identified. The area under the receiver operator curve for the LRINEC score in detecting NF was 0.925 (0.890-0.959, P < 0.001). The sensitivity of the LRINEC ≥5 for NF was 76.3%, with a specificity of 93.1%. The positive and negative predictive values were 95.5 and 88.1%, respectively. The positive and negative likelihood ratios were 11 and 0.25.
The LRINEC score is a useful, robust, non-invasive and easily calculated scoring system that can be used as an adjunct to early diagnosis of NF. However, a high degree of clinical suspicion remains the most important factor in early diagnosis of NF.
软组织感染是澳大利亚北领地顶端地区的一项重大健康负担。坏死性筋膜炎（NF）的死亡率为8%至40%。早期识别和积极的手术清创是成功治疗的基石。Wong等人开发的坏死性筋膜炎实验室风险指标（LRINEC）评分使用六个常规生化变量来辅助早期诊断。我们旨在评估LRINEC评分在我们人群中的诊断效能。
对2005年至2013年间患有NF的患者进行回顾性研究。选择一组时间匹配的脓肿/蜂窝织炎患者作为对照。入院时的血液样本用于计算LRINEC评分。术中发现NF作为比较的金标准定义。评估LRINEC评分的诊断准确性。
确定了98例NF患者和205例对照患者。LRINEC评分检测NF的受试者操作特征曲线下面积为0.925（0.890 - 0.959，P < 0.001）。LRINEC≥5对NF的敏感性为76.3%，特异性为93.1%。阳性和阴性预测值分别为95.5%和88.1%。阳性和阴性似然比分别为11和0.25。
LRINEC评分是一种有用、可靠、非侵入性且易于计算的评分系统，可作为NF早期诊断的辅助手段。然而，高度的临床怀疑仍然是NF早期诊断中最重要的因素。
