Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections.
Modified LRINEC
Necrotizing fasciitis
Predictor
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
26 05 2021
26 05 2021
Historique:
received:
19
04
2021
accepted:
18
05
2021
entrez:
27
5
2021
pubmed:
28
5
2021
medline:
30
9
2021
Statut:
epublish
Résumé
We conducted this study to promote a modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score and evaluate the utility in distinguishing necrotizing fasciitis (NF) from other soft-tissue infections. A retrospective cohort study of hospitalized patients with NF diagnosed by surgical finding was conducted in two tertiary hospital in southern Taiwan between January 2015 and January 2020. Another group was matched by controls with non-necrotizing soft tissue infections based on time, demographics, and immune status. Data such as infectious location, comorbidities, and laboratory findings were recorded and compared. Logistics regression were used to determine the association with NF after adjustment for confounders and MLRINEC score was developed by then. Receiver operating curve (ROC) and the area under the curve (AUC) were used to evaluate its discriminating ability. A total of 303 patients were included; 101 in NF group and 202 in non-NF group. We added serum lactate and comorbid liver disease to the original LRINEC score and re-defined the cut-off values for 3 variables to develop the MLRINEC score. The cut-off value for MLRINEC score was 12 points with corresponding sensitivity of 91.8% and a specificity of 88.4%, and the area under ROC (AUC) was 0.893 (95% CI, 0.723 to 0.948; p < 0.01). MLRINEC score shows a high sensitivity and specificity in distinguishing NF from non-necrotizing soft-tissue infections. Patients with a MLRINEC score > 12 points should be highly suspected of presence of necrotizing fasciitis.
Sections du résumé
BACKGROUND
We conducted this study to promote a modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score and evaluate the utility in distinguishing necrotizing fasciitis (NF) from other soft-tissue infections.
METHOD
A retrospective cohort study of hospitalized patients with NF diagnosed by surgical finding was conducted in two tertiary hospital in southern Taiwan between January 2015 and January 2020. Another group was matched by controls with non-necrotizing soft tissue infections based on time, demographics, and immune status. Data such as infectious location, comorbidities, and laboratory findings were recorded and compared. Logistics regression were used to determine the association with NF after adjustment for confounders and MLRINEC score was developed by then. Receiver operating curve (ROC) and the area under the curve (AUC) were used to evaluate its discriminating ability.
RESULT
A total of 303 patients were included; 101 in NF group and 202 in non-NF group. We added serum lactate and comorbid liver disease to the original LRINEC score and re-defined the cut-off values for 3 variables to develop the MLRINEC score. The cut-off value for MLRINEC score was 12 points with corresponding sensitivity of 91.8% and a specificity of 88.4%, and the area under ROC (AUC) was 0.893 (95% CI, 0.723 to 0.948; p < 0.01).
CONCLUSION
MLRINEC score shows a high sensitivity and specificity in distinguishing NF from non-necrotizing soft-tissue infections. Patients with a MLRINEC score > 12 points should be highly suspected of presence of necrotizing fasciitis.
Identifiants
pubmed: 34039397
doi: 10.1186/s13017-021-00373-0
pii: 10.1186/s13017-021-00373-0
pmc: PMC8157441
doi:
Substances chimiques
Biomarkers
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
26Commentaires et corrections
Type : ErratumIn
Références
Wong C-H, Chang H-C, Pasupathy S, Khin L-W, Tan J-L, Low C-O. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85-A:1454–60.
doi: 10.2106/00004623-200308000-00005
Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician. 2003;68(2):323–8.
pubmed: 12892352
Ozalay M, Ozkoc G, Akpinar S, Hersekli MA, Tandogan RN. Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality. Foot Ankle Int. 2006;27(8):598–605. https://doi.org/10.1177/107110070602700806 .
doi: 10.1177/107110070602700806
pubmed: 16919212
Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg. 2011;6(1):46. https://doi.org/10.1186/1749-7922-6-46 .
doi: 10.1186/1749-7922-6-46
pubmed: 22196774
pmcid: 3310784
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(8):344–62. https://doi.org/10.1067/j.cpsurg.2014.06.001 .
doi: 10.1067/j.cpsurg.2014.06.001
pubmed: 25069713
pmcid: 4199388
Chang C-P, Hsiao C-T, Lin C-N. Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study. World J Emerg Surg. 2018;13:1–1.
doi: 10.1186/s13017-018-0207-0
Kim MC, Kim S, Cho EB, Lee GY, Choi SH, Kim SO, et al. Utility of magnetic resonance imaging for differentiating necrotizing fasciitis from severe cellulitis: a Magnetic Resonance Indicator for Necrotizing Fasciitis (MRINEC) Algorithm. J Clin Med. 2020;9(9):3040.
doi: 10.3390/jcm9093040
Lin CN, Hsiao CT, Chang CP, Huang TY, Hsiao KY, Chen YC, et al. The relationship between fluid accumulation in ultrasonography and the diagnosis and prognosis of patients with necrotizing fasciitis. Ultrasound Med Biol. 2019 Jul;45(7):1545–50. https://doi.org/10.1016/j.ultrasmedbio.2019.02.027 .
doi: 10.1016/j.ultrasmedbio.2019.02.027
pubmed: 31031033
Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41. https://doi.org/10.1097/01.CCM.0000129486.35458.7D .
doi: 10.1097/01.CCM.0000129486.35458.7D
pubmed: 15241098
Tan J, Koh B, Hong C, Lim S, Liang S, Chan G, et al. A comparison of necrotising fasciitis in diabetics and non-diabetics: a review of 127 patients. Bone Joint J. 2016;11:1563–8.
doi: 10.1302/0301-620X.98B11.37526
Holland MJ. Application of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score to patients in a tropical tertiary referral centre. Anaesth Intensive Care. 2009;37(4):588–92. https://doi.org/10.1177/0310057X0903700416 .
doi: 10.1177/0310057X0903700416
pubmed: 19681416
Abdullah M, McWilliams B, Khan SU. Reliability of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score. Surgeon. 2019;17(5):309–18. https://doi.org/10.1016/j.surge.2018.08.001 .
doi: 10.1016/j.surge.2018.08.001
pubmed: 30166238
Johnson L, Crisologo P, Sivaganesan S, Caldwell C, Henning J. Evaluation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for detecting necrotizing soft tissue infections in patients with diabetes and lower extremity infection. Diabetes Res Clin Pract. 2020;171:108520.
doi: 10.1016/j.diabres.2020.108520
Khosravani H, Shahpori R, Stelfox HT, et al. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care. 2009;13(3):R90. https://doi.org/10.1186/cc7918 .
doi: 10.1186/cc7918
pubmed: 19523194
pmcid: 2717461
Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37:1670–7.
doi: 10.1097/CCM.0b013e31819fcf68
Tang Y, Choi J, Kim D. et al, Clinical predictors of adverse outcome in severe sepsis patients with lactate 2 to 4 mM admitted to the hospital. QJM. Published Online First: 4 Sep 2014. https://doi.org/10.1093/qjmed/hcu186 .
Azevedo LC, Park M, Salluh JI, et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care. 2013;17:R63. https://doi.org/10.1186/cc12594 .
doi: 10.1186/cc12594
pubmed: 23557378
pmcid: 3672504
Bakker J, Gris P, Coffernils M, et al. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. 1996;171:221–6.
doi: 10.1016/S0002-9610(97)89552-9
Al-Hindawi A, McGhee J, Lockey J, Vizcaychipi M. Validation of the laboratory risk indicator for necrotising fasciitis scoring system (LRINEC) in a Northern European population. J Plast Reconstr Aesthet Surg. 2017;70(1):141–3. https://doi.org/10.1016/j.bjps.2016.05.014 .
doi: 10.1016/j.bjps.2016.05.014
pubmed: 27297690
Ogawa M, Yokoo S, Takayama Y, Kurihara J, Makiguchi T, Shimizu T. Laboratory Risk Indicator for Necrotizing Fasciitis of the Oro-Cervical Region (LRINEC-OC): A Possible Diagnostic Tool for Emergencies of the Oro-Cervical Region. Emerg Med Int. 2019;2019:1573453.
doi: 10.1155/2019/1573453
Captain N, Anandi A. A study on validation of modified LRINEC scoring system for the diagnosis of necrotising fasciitis in patients with soft tissue infection. Int Arch Integr Med. 2020;7(3):35–40.
Putnam LR, Richards MK, Sandvall BK, Hopper RA, Waldhausen JH, Harting MT. Laboratory evaluation for pediatric patients with suspected necrotizing soft tissue infections: a case-control study. J Pediatr Surg. 2016;51(6):1022–5. https://doi.org/10.1016/j.jpedsurg.2016.02.076 .
doi: 10.1016/j.jpedsurg.2016.02.076
pubmed: 27233372
Chang CP, Fann WC, Wu SR, Lin CN, Hsiao CT. Lactate on emergency department arrival as a predictor of in-hospital mortality in necrotizing fasciitis: a retrospective study. J Orthop Surg Res. 2019;14(1):73. https://doi.org/10.1186/s13018-019-1108-y .
doi: 10.1186/s13018-019-1108-y
pubmed: 30841912
pmcid: 6402084
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55. https://doi.org/10.1378/chest.101.6.1644 .
doi: 10.1378/chest.101.6.1644
pubmed: 1303622
Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med. 2003;31(1):104–12. https://doi.org/10.1097/00003246-200301000-00017 .
doi: 10.1097/00003246-200301000-00017
pubmed: 12545002