Ali Muhammad Arsalan, Azmat Usama Bin, Shah Hamad Ali, Hussain Syed Munim, Qasim Syed M, Jameel Gulfam, Ghazanfar Aamir, Mehmood Muhammad Asim
General Surgery, Kahuta Research Laboratories (KRL) Hospital, Islamabad, PAK.
Orthopedic Surgery, Kahuta Research Laboratories (KRL) Hospital, Islamabad, PAK.
Cureus. 2025 Aug 14;17(8):e90126. doi: 10.7759/cureus.90126. eCollection 2025 Aug.
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.
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.
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).
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%.
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.
坏死性筋膜炎（NF）是一种进展迅速、危及生命的软组织感染，若不及早诊断和治疗，会导致高发病率和死亡率。由于其临床表现往往不明显，早期识别仍然是一项诊断挑战。
本研究旨在确定坏死性筋膜炎实验室风险指标（LRINEC）评分在预测NF入院患者的疾病特异性死亡率和发病率（脓毒症）方面的预测准确性。
这是一项在巴基斯坦伊斯兰堡卡胡塔研究实验室（KRL）医院外科进行的验证性研究，时间为2022年1月至2023年9月。通过连续抽样纳入了95例疑似NF的患者。入院时，使用六个实验室变量计算LRINEC评分：血红蛋白、白细胞计数、血清钠、血清肌酐、C反应蛋白（CRP）和随机血糖。对患者进行28天随访以评估结局。疾病特异性死亡率定义为28天内死亡；脓毒症采用标准临床标准进行诊断。通过敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）确定LRINEC评分>9的诊断准确性。
95例患者中，男性62例（65.3%），女性33例（34.7%），平均年龄48.25±12.19岁。65例（68.4%）患者的LRINEC评分>9。对于预测死亡率，LRINEC评分>9的敏感性为100%，特异性为49.1%，PPV为33.8%，NPV为100%。对于预测脓毒症，敏感性为34例（79.1%），特异性为41例（65.2%），PPV为52.3%，NPV为87.2%。
LRINEC评分>9是识别因NF有死亡和脓毒症风险患者的高度敏感工具。然而，由于其特异性中等，应结合临床评估、影像学检查和早期手术干预使用，以提高诊断准确性和改善结局。
