Department of General Surgery, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, 2025, New Zealand.
Epworth Hospital, 89 Bridge Road, Richmond, VIC, 3121, Australia.
World J Surg. 2019 Oct;43(10):2393-2400. doi: 10.1007/s00268-019-05061-4.
The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was developed to aid the diagnosis of necrotizing fasciitis and guide management [1].
To validate the LRINEC score and identify clinical predictors to develop a refined diagnostic scoring tool for the diagnosis of necrotizing fasciitis at Middlemore Hospital, New Zealand.
This was a retrospective case-control study of patients admitted to Middlemore Hospital with necrotizing fasciitis and severe cellulitis between January 2000 and December 2010. The LRINEC scores at admission were evaluated for performance in discriminating between cases of necrotizing fasciitis and severe cellulitis. Cases and controls were randomized into developmental and validation cohorts. Univariate and multivariate logistic regression analysis of demographic, clinical, and laboratory variables for the diagnosis of necrotizing fasciitis was performed. The identified independent predictors were used to develop a new diagnostic scoring tool.
The area under the receiver operating characteristic curve (C-statistic) of a LRINEC score ≥6 for the diagnosis of necrotizing fasciitis was 0.679. The newly developed SIARI score [Site other than the lower limb, Immunosuppression, Age < 60 years, Renal impairment (creatinine > 141), and Inflammatory markers (CRP ≥ 150, WCC > 25] demonstrated superior diagnostic ability compared with the LRINEC score in both the developmental (C-statistic: 0.832 vs. 0.691, p < 0.001) and validation cohorts (C-statistic: 0.847 vs. 0.667, p < 0.001).
The LRINEC score exhibited only modest discriminative performance in this cohort, while the SIARI score is a simplified tool that demonstrates superior diagnostic ability for detecting necrotizing fasciitis. Future external validation studies are required to confirm the trends observed in this study.
实验室风险指标坏死性筋膜炎评分系统（LRINEC）的开发旨在辅助坏死性筋膜炎的诊断并指导治疗[1]。
验证 LRINEC 评分并确定临床预测因子，以开发一种更精细的诊断评分工具，用于新西兰 Middlemore 医院坏死性筋膜炎的诊断。
这是一项回顾性病例对照研究，纳入 2000 年 1 月至 2010 年 12 月期间在 Middlemore 医院因坏死性筋膜炎和严重蜂窝织炎住院的患者。入院时评估 LRINEC 评分在区分坏死性筋膜炎和严重蜂窝织炎病例中的表现。病例和对照随机分为开发和验证队列。对人口统计学、临床和实验室变量进行单变量和多变量逻辑回归分析，以诊断坏死性筋膜炎。使用确定的独立预测因子开发新的诊断评分工具。
LRINEC 评分≥6 用于诊断坏死性筋膜炎的受试者工作特征曲线下面积（C 统计量）为 0.679。新开发的 SIARI 评分[部位非下肢、免疫抑制、年龄<60 岁、肾功能不全（肌酐>141）和炎症标志物（CRP≥150，WCC>25）]与 LRINEC 评分相比，在开发队列（C 统计量：0.832 与 0.691，p<0.001）和验证队列（C 统计量：0.847 与 0.667，p<0.001）均显示出更好的诊断能力。
在本队列中，LRINEC 评分的鉴别性能仅为中等，而 SIARI 评分是一种简化工具，可显示出更好的诊断能力，用于检测坏死性筋膜炎。需要进一步的外部验证研究来确认本研究中观察到的趋势。
