A prospective study to assess the prognosis of patients with necrotizing fasciitis using laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring system in a tertiary care hospital
-
Rekha Walwekar
,
Vignesh Ramalingam
Abstract
Introduction
Necrotizing fasciitis (NF) is a rare but potentially fatal infection, involving the subcutaneous tissue and fascia. The incidence of NF worldwide ranges from 0.30 to 15 cases per 100,000 populations and mortality remains high at 25 %.
Objectives
To classify severity of necrotizing fasciitis and assess the prognosis of necrotizing fasciitis using the LRINEC Scoring system.
Methods
A thorough history and detailed clinical examination was done. Patient underwent necessary investigations like hemoglobulin, total leukocyte count, serum sodium, serum creatinine, random blood sugar, and C-reactive protein. Based on the investigations, two groups were formulated, LRINEC score <6 (low risk) and ≥6 (high risk). Then prognosis was assessed. The results were compared between the two groups.
Results
In our study, a total of 124 patients were included with 62 of them with LRINEC score of <6 and 62 patients with LRINEC score ≥6. The sensitivity and specificity for predicting the septic shock and mortality with LRINEC score is 94 % and 70 % and 94 % and 71 %, respectively.
Conclusions
LRINEC score is a simple clinical tool for predicting the prognostic outcomes in patients with necrotizing fasciitis. LRINEC score of ≥6 have poorer prognosis in the form septic shock and eventual mortality.
Acknowledgments
I want to thank Dr. K.G. Byakodi, for his continued support to complete the study.
-
Research ethics: Study approval was obtained from Institutional Ethics Committee (Reg No- ECR/486/Inst/KA/2013/RR-16).
-
Informed consent: Informed consent was obtained from the patients or their relatives, and all methods were performed in accordance with the GCP guidelines and regulations.
-
Author contributions: RW, VR, AW.
-
Use of Large Language Models, AI and Machine Learning Tools: None declared.
-
Conflict of interest: Nil.
-
Research funding: Nil.
-
Data availability: RGUHS dissertation section.
References
1. Puvanendran, R, Huey, JC, Pasupathy, S. Necrotizing fasciitis. Can Fam Physician 2009;55:981–7.Search in Google Scholar
2. Kessenich, CR, Bahl, A. Necrotizing fasciitis: understanding the deadly results of the uncommon ‘flesh-eating bacteria. AJN The American Journal of Nursing 2004;104:51–5. https://doi.org/10.1097/00000446-200409000-00024.Search in Google Scholar PubMed
3. Tantirat, P, Rattanathumsaku, T, Praekunatham, H, Pachanee, K, Suphanchaimat, R. Epidemiological situation of necrotizing fasciitis and factors in Thailand and factors associated with its morbidity and mortality, 2014–2018. Risk Manag Healthc Policy 2020;13:1613–24. https://doi.org/10.2147/RMHP.S263974.Search in Google Scholar PubMed PubMed Central
4. Study, OG, Kaul, R, McGeer, A, Low, DE, Green, K, Schwartz, B, et al.. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Am J Med 1997;103:18–24. https://doi.org/10.1016/s0002-9343(97)00160-5.Search in Google Scholar PubMed
5. Chen, LL, Fasolka, B, Treacy, C. Necrotizing fasciitis: a comprehensive review. Nursing 2020;50:34–40. https://doi.org/10.1097/01.nurse.0000694752.85118.62.Search in Google Scholar
6. Gupta, Y, Chhetry, M, Pathak, KR, Jha, RK, Ghimire, N, Mishra, BN, et al.. Risk factors for necrotizing fasciitis and its outcome at a tertiary care centre. J Ayub Med Coll Abbottabad 2016;28:680–2.Search in Google Scholar
7. Khamnuan, P, Chongruksut, W, Jearwattanakanok, K, Patumanond, J, Yodluangfun, S, Tantraworasin, A. Necrotizing fasciitis: risk factors of mortality. Risk Manag Healthc Policy 2019;7:1–7. https://doi.org/10.2147/RMHP.S77691.Search in Google Scholar PubMed PubMed Central
8. Park, KH, Jung, SI, Jung, YS, Shin, JH, Hwang, JH. Marine bacteria as a leading cause of necrotizing fasciitis in coastal areas of South Korea. Am J Trop Med Hyg 2009;80:646–50. https://doi.org/10.4269/ajtmh.2009.80.646.Search in Google Scholar
9. Haywood, CT, McGeer, A, Low, DE. Clinical experience with 20 cases of group A streptococcus necrotizing fasciitis and myonecrosis: 1995 to 1997. Plast Reconstr Surg 1999;103:1567–73. https://doi.org/10.1097/00006534-199905000-00003.Search in Google Scholar
10. Goodell, KH, Jordan, MR, Graham, R, Cassidy, C, Nasraway, SA. Rapidly advancing necrotizing fasciitis caused by photobacterium (Vibrio) damsela: a hyperaggressive variant. Crit Care Med 2004;32:278–81. https://doi.org/10.1097/01.ccm.0000104920.01254.82.Search in Google Scholar PubMed
11. Trent, JT, Kirsner, RS. Diagnosing necrotizing fasciitis. Adv Skin Wound Care 2002;15:135–8. https://doi.org/10.1097/00129334-200205000-00010.Search in Google Scholar PubMed
12. Brantigan, C, Senkowski, J. Group A beta haemolytic streptococcal necrotizing fasciitis. Wounds 1995;7:62–8.Search in Google Scholar
13. Shiroff, AM, Herlitz, GN, Gracias, VH. Necrotizing soft tissue infections. J Intensive Care Med 2014;29:138–44. https://doi.org/10.1177/0885066612463680.Search in Google Scholar PubMed
14. Hakkarainen, TW, Kopari, NM, Pham, TN, Evans, HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 2014;51:344. https://doi.org/10.1067/j.cpsurg.2014.06.001.Search in Google Scholar PubMed PubMed Central
15. Erichsen, AA, Egerod, I, Knudsen, VE, Fagerdahl, AM. Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative nordic multi-center study. BMC Infect Dis 2018;18:429. https://doi.org/10.1186/s12879-018-3355-7.Search in Google Scholar PubMed PubMed Central
16. Wilson, MP, Schneir, AB. A case of necrotizing fasciitis with a LRINEC score of zero: clinical suspicion should trump scoring systems. J Emerg Med 2013;44:928–31. https://doi.org/10.1016/j.jemermed.2012.09.039.Search in Google Scholar PubMed
17. Wong, CH, Khin, LW, Heng, KS, Tan, KC, Low, CO. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535–41. https://doi.org/10.1097/01.ccm.0000129486.35458.7d.Search in Google Scholar PubMed
18. Fernando, SM, Tran, A, Cheng, W, Rochwerg, B, Kyeremanteng, K, Seely, AJ, et al.. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis. Ann Surg 2019;1:58–65. https://doi.org/10.1097/sla.0000000000002774.Search in Google Scholar PubMed
19. Bechar, J, Sepehripour, S, Hardwicke, J, Filobbos, G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll Surg Engl 2017;99:341–6. https://doi.org/10.1308/rcsann.2017.0053.Search in Google Scholar PubMed PubMed Central
20. El-Menyar, A, Asim, M, Mudali, IN, Mekkodathil, A, Latifi, R, Al-Thani, H. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role. Scand J Trauma Resuscitation Emerg Med 2017;25:1–9. https://doi.org/10.1186/s13049-017-0359-z.Search in Google Scholar PubMed PubMed Central
21. Su, YC, Chen, HW, Hong, YC, Chen, CT, Hsiao, CT, Chen, IC. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. ANZ J Surg 2008;78:968–72. https://doi.org/10.1111/j.1445-2197.2008.04713.x.Search in Google Scholar PubMed
22. Hoesl, V, Kempa, S, Prantl, L, Ochsenbauer, K, Hoesl, J, Kehrer, A, et al.. The LRINEC score-an indicator for the course and prognosis of necrotizing fasciitis? J Clin Med 2022;11:3583. https://doi.org/10.3390/jcm11133583.Search in Google Scholar PubMed PubMed Central
23. Hsiao, CT, Chang, CP, Huang, TY, Chen, YC, Fann, WC. Prospective validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for necrotizing fasciitis of the extremities. PLoS One 2020;15:359–164. https://doi.org/10.1371/journal.pone.0227748.Search in Google Scholar PubMed PubMed Central
24. Tarricone, A, Mata, K, Gee, A, Axman, W, Buricea, C, Mandato, MG, et al.. A systematic review and meta-analysis of the effectiveness of LRINEC score for predicting upper and lower extremity necrotizing fasciitis. J Foot Ankle Surg 2022;61:384–9. https://doi.org/10.1053/j.jfas.2021.09.015.Search in Google Scholar PubMed
25. Singh, DK, Kapoor, R, Yadav, PS, Saxena, S, Agarwal, K, Solanki, RS, et al.. Morbidity and mortality of necrotizing fasciitis and their prognostic factors in children. J Indian Assoc Pediatr Surg 2022;27:577–84. https://doi.org/10.4103/jiaps.jiaps_222_21.Search in Google Scholar PubMed PubMed Central
26. Garcia, PR, Tarriño, A, Betancourt, JB, Viladomiu, AS, Guillermo, JR, Pérez, L, et al.. Necrotizing fasciitis: usefulness of the LRINEC score in a third-level hospital. Injury 2021;52:S8–15. https://doi.org/10.1016/j.injury.2021.02.093.Search in Google Scholar PubMed
Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/jbcpp-2025-0117).
© 2025 Walter de Gruyter GmbH, Berlin/Boston
