Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for the Assessment of Early Necrotizing Fasciitis: A Systematic Review of the Literature

SLR - November 2018 - Harshil Patel

Reference: Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for the Assessment of Early Necrotizing Fasciitis: A Systematic Review of the Literature. Ann R Coll Surg Engl. 2017; 99: 341–346.

Scientific Literature Review

Reviewed By: Harshil Patel, DPM
Residency Program: Bethesda Hospital East, Boynton Beach, FL

Podiatric Relevance: One of the most significant surgical emergencies treated by podiatrists is a severe infection known as necrotizing fasciitis. Necrotizing fasciitis, also known as the flesh-eating disease, is an infection that affects the skin, subcutaneous tissue and fascia and is found to commonly have an abrupt onset and to spread rapidly. It can also be fatal if the diagnosis is delayed and if not treated quickly and appropriately in a timely manner. Patients with uncontrolled diabetes and foot ulcers are at a higher risk for developing necrotizing fasciitis. This study offers a literature review on the accuracy of using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for the early diagnosis of necrotizing fasciitis.

Methods: A systematic review was performed of articles involving necrotizing fasciitis and the use of the LRINEC score from January 1, 2004 to June 1, 2015. The review involved the following electronic databases: EMBASE, MEDLINE and the Cochrane Database of Systematic Reviews. Two researchers independently selected articles that satisfied the inclusion and exclusion criteria. A meta-analysis was performed, and comparisons between groups were made using a 95 percent confidence interval. The mean, standard deviations, Pearson Correlation coefficient (r), two-tailed student T test, two-tailed single-sample T test and receiver operator curve (ROC) plots were also calculated, with the threshold for significance being P < 0.05.

Results: Of the 77 articles, 16 met the inclusion and exclusion criteria and were included in the systemic review. Of the 16 studies, a total of 846 patients were included. The mean LRINEC score for patients found to have necrotizing fasciitis was 6.06 and for those who were found not to have necrotizing fasciitis was 2.45. The Pearson correlation coefficient (r) between LRINEC score and positive diagnosis of necrotizing fasciitis was 0.637 (P = 0.01). A two-tailed student T test was used to compare patients with a positive diagnosis of necrotizing fasciitis and patients with a negative diagnosis. A two-tailed analysis of patients with LRINEC scores at the extremes of the range was t = 2.98 (P = 0.01). A two-tailed single-sample T test was used to determine the value at which the LRINEC score was statistically significant in patients with necrotizing fasciitis. A LRINEC score of 6 was found to be insignificant with t = 0.14 (P = 0.44). A LRINEC score of 7.1 was found to be significant with t = –1.93 (P = 0.03).

Conclusions: The LRINEC score was found to have a statistically positive correlation in the true clinical diagnosis of necrotizing fasciitis. The significance of this finding helps in the early clinical diagnosis of necrotizing fasciitis and allows surgeons to proceed with surgical intervention in a timely manner as needed to manage this devastating and severe infection, thus giving patients the best chance at preventing a loss of limb or even possibly loss of life.