Mary Thomas Nimil, Sharma Minaxi, Sukhadia Mukta, Merin George Ardra
General Surgery, Rabindranath Tagore (RNT) Medical College, Udaipur, IND.
Surgery, Rabindranath Tagore (RNT) Medical College, Udaipur, IND.
Cureus. 2023 Apr 18;15(4):e37775. doi: 10.7759/cureus.37775. eCollection 2023 Apr.
Necrotizing fasciitis (NF) is a lethal soft tissue infection involving skin and subcutaneous tissue with significant morbidity and mortality.
To validate the diagnostic and prognostic role of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system for NF in patients who present with soft tissue infections.
The study was conducted on 100 patients who presented with soft tissue infections. Based on the histopathological findings, they were divided into NF and non-necrotizing soft tissue infection groups. Patients were clinically assessed. The lab parameters were assessed and the LRINEC score was calculated. Patients were stratified based on score and grouped into low, intermediate, and high risk. For patients who went into sepsis, the death rate and length of hospital stay, including ICU, were noted based on the scoring system.
In our study, the diagnostic role of LRINEC score ≥ 6 had a sensitivity of 85.7% and specificity of 62.7%, and score ≥ 8 had a sensitivity of 67.3% and specificity of 82.3% with a positive predictive value (PPV) of 78.5 and negative predictive value (NPV) of 72.4, of which 8 is a better cut-off as a diagnostic criterion. The area under the curve was found to be 0.835. To predict the prognostic role, a cut-off value was calculated from the receiver operating characteristic curves of both mortality and sepsis patients in relation to the LRINEC score of 9. With the LRINEC score cut-off as 9, with mortality and sepsis as variables, the sensitivity was 50% and 53.3%, specificity was 94.2% and 91.4%, PPV was 78.9% and 72.7%, and NPV was 81.4% and 82%, respectively.
The LRINEC score is quick, safe, reproducible, noninvasive, cost-effective, and easily calculated, and has high sensitivity and specificity to predict early diagnosis, and it could be used for risk stratification and prognosis of necrotizing soft tissue infections.
坏死性筋膜炎（NF）是一种致命的软组织感染，累及皮肤和皮下组织，具有较高的发病率和死亡率。
验证坏死性筋膜炎实验室风险指标（LRINEC）评分系统对软组织感染患者坏死性筋膜炎的诊断和预后价值。
对100例软组织感染患者进行研究。根据组织病理学结果，将他们分为坏死性筋膜炎组和非坏死性软组织感染组。对患者进行临床评估。评估实验室参数并计算LRINEC评分。根据评分对患者进行分层，分为低、中、高风险组。对于发生脓毒症的患者，根据评分系统记录死亡率和住院时间（包括重症监护病房）。
在我们的研究中，LRINEC评分≥6的诊断敏感度为85.7%，特异度为62.7%；评分≥8的敏感度为67.3%，特异度为82.3%，阳性预测值（PPV）为78.5，阴性预测值（NPV）为72.4，其中8作为诊断标准的截断值更佳。曲线下面积为0.835。为预测预后价值，根据死亡率和脓毒症患者与LRINEC评分的受试者工作特征曲线计算出截断值为9。以LRINEC评分截断值为9，以死亡率和脓毒症为变量，敏感度分别为50%和53.3%，特异度分别为94.2%和91.4%，PPV分别为78.9%和72.7%，NPV分别为81.4%和82%。
LRINEC评分快速、安全、可重复、无创、经济有效且易于计算，对预测早期诊断具有较高的敏感度和特异度，可用于坏死性软组织感染的风险分层和预后评估。
