Predictive Accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score in Forecasting Mortality and Morbidity Among Necrotizing Fasciitis Patients at a Tertiary Care Hospital in Islamabad.

BACKGROUND

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection associated with high morbidity and mortality if not diagnosed and treated early. Due to its often subtle clinical presentation, early identification remains a diagnostic challenge.

OBJECTIVE

This study aimed to determine the predictive accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis(LRINEC) score in forecasting disease-specific mortality and morbidity (sepsis) among patients admitted with NF.

METHODOLOGY

This is a validation study conducted at the Department of Surgery of Kahuta Research Laboratories (KRL) Hospital in Islamabad, Pakistan, from January 2022 to September 2023. A total of 95 patients suspected of NF were enrolled through consecutive sampling. On admission, LRINEC scores were calculated using six laboratory variables: hemoglobin, white blood cell count, serum sodium, serum creatinine, C-reactive protein (CRP), and random blood glucose. Patients were followed for 28 days to assess outcomes. Disease-specific mortality was defined as death within 28 days; sepsis was diagnosed using standard clinical criteria. Diagnostic accuracy of an LRINEC score >9 was determined through sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS

Among 95 patients, 62 (65.3%) were male and 33 (34.7%) were female, with a mean age of 48.25 ± 12.19 years. An LRINEC score >9 was observed in 65 (68.4%) patients. For predicting mortality, an LRINEC score >9 demonstrated a sensitivity of 100%, a specificity of 49.1%, a PPV of 33.8%, and an NPV of 100%. For predicting sepsis, sensitivity was 34 (79.1%), specificity 41 (65.2%), PPV 52.3%, and NPV 87.2%.

CONCLUSION

An LRINEC score >9 is a highly sensitive tool for identifying patients at risk of mortality and sepsis due to NF. However, due to its moderate specificity, it should be used in conjunction with clinical assessment, imaging, and early surgical intervention to improve diagnostic precision and outcomes.