How is the laboratory risk indicator for necrotizing fasciitis (LRINEC) used?

Updated: Sep 02, 2020
  • Author: Steven A Schulz, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Nonetheless, a retrospective study by El-Menyar et al suggested that the LRINEC score is not only useful as a diagnostic tool but also as a prognostic one. In the study, patients with an LRINEC score of 6 or above had a greater tendency toward diabetes mellitus, Pseudomonas aeruginosa infection, and a higher Sequential Organ Failure Assessment (SOFA) score. They also tended to have a longer period of intensive care, a longer hospital stay, and higher septic shock and mortality rates. [67]

However, a retrospective study by Neeki et al indicated that the LRINEC score may prove inaccurate when used in the emergency department for necrotizing fasciitis risk stratification and the differentiation of cellulitis from necrotizing fasciitis. The investigators found that in emergency department patients with confirmed cellulitis, the LRINEC score had a high false-positive rate, classifying 10.8% of these patients as being at moderate or high risk for necrotizing fasciitis. In emergency department patients with confirmed necrotizing fasciitis, however, the LRINEC score had a high false-negative rate, classifying 63.8% of these patients as being at low risk for the disease. The study also found that in both the cellulitis and necrotizing fasciitis patients, the misclassification rate was higher for nondiabetic patients than for patients with diabetes. The results of the report indicate that a high index of clinical suspicion is warranted in the use of the LRINEC score in the emergency department. [68]

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