Department of Plastic, Reconstructive and Hand Surgery, Burn Center for Severe Burn Injuries, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg/Prof.-Ernst-Nathan Straße 1, 90419 Nuremberg, Germany.
Department of Plastic, Reconstructive and Hand Surgery, Burn Center for Severe Burn Injuries, Klinikum Nuremberg Hospital, Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg/Prof.-Ernst-Nathan Straße 1, 90419 Nuremberg, Germany.
J Plast Reconstr Aesthet Surg. 2023 Feb;77:228-235. doi: 10.1016/j.bjps.2022.11.061. Epub 2022 Dec 1.
Necrotising fasciitis (NF) represents a rare but often life-threatening condition. Early diagnosis and surgical treatment are of vital importance. The LRINEC score was developed to distinguish necrotising fasciitis from other soft tissue infections (STI) at initial evaluation using six laboratory values. In this retrospective study, we attempted to determine the diagnostic and prognostic value of the LRINEC score.
A total of 125 patients, hospitalised in our clinic between 2003 and 2021 with a histologically confirmed diagnosis of necrotising fasciitis (NF group) and 319 patients with surgically treated soft tissue infections (STI group) were included in this study. Individual LRINEC scores were calculated and analysed retrospectively.
The sensitivity of the LRINEC score at the cut-off point of ≥ 6 was 59%, whereas the specificity was 82%. The positive and negative predictive values were 57% and 84%, respectively. The mean LRINEC score was significantly higher in the NF group than in the STI group (6.0 compared to 2.4, respectively). All clinical outcome parameters such as amputation and mortality rates (15% vs 1%) were found to be significantly higher in the NF group (p<0.001). Within the NF group, there was no statistically significant association between the LRINEC score and clinical outcomes except for the necessary number of operations.
In isolation, we found the LRINEC score not to be a reliable enough diagnostic tool for the differentiation between NF and other soft tissue infections, because of its low sensitivity. Although we cannot recommend it as a prognostic tool either, we do believe it can be a useful adjunct to the clinical suspicion of NF.
坏死性筋膜炎（NF）是一种罕见但常危及生命的疾病。早期诊断和手术治疗至关重要。LRINEC 评分是一种基于 6 项实验室指标的评分系统，用于在初始评估时区分坏死性筋膜炎和其他软组织感染（STI）。在本回顾性研究中，我们试图确定 LRINEC 评分的诊断和预后价值。
共纳入 2003 年至 2021 年期间在我院住院、经组织学证实为坏死性筋膜炎（NF 组）的 125 例患者和接受手术治疗的软组织感染（STI 组）的 319 例患者。回顾性计算并分析每位患者的 LRINEC 评分。
LRINEC 评分≥6 时的灵敏度为 59%，特异性为 82%。阳性和阴性预测值分别为 57%和 84%。NF 组的平均 LRINEC 评分明显高于 STI 组（分别为 6.0 和 2.4）。NF 组的所有临床结局参数，如截肢率和死亡率（15%比 1%）均显著高于 STI 组（p<0.001）。在 NF 组中，LRINEC 评分与临床结局之间除手术次数外无统计学显著相关性。
单独使用时，LRINEC 评分作为 NF 和其他软组织感染的鉴别诊断工具的灵敏度较低，因此我们认为其不够可靠。虽然我们也不推荐其作为预后工具，但我们认为其有助于临床医生怀疑 NF 时进行辅助诊断。
