Borschitz et al modified the laboratory risk indicator for necrotizing fasciitis (LRINEC) of Wong et al. The authors are from Johannes Gutenberg University Mainz and Center for Coloproctology/Surgery in Mainz, Germany.
Changes from original LRINEC inlcude:
(1) removal of: serum sodiu, glucose
(2) addition of: erythrocyte count, fibrinogen, clinical factors (pain, fever, tachycardia, acute renal injury)
Parameters:
(1) C-reactive protein (CRP) in mg/dL
(2) white blood cell count per µL
(3) erythrocyte count per µL
(4) hemoglobin in g/dL
(5) serum creatinine in µmol/L
(6) plasma fibrinogen in mg/dL
(7) pain
(8) body temperature in °C
(9) pulse in beats/minute
(10) signs of acute renal injury
|
Parameter
|
Finding
|
Points
|
|
C-reactive protein
|
<= 150 mg/dL
|
0
|
|
|
> 150 mg/dL
|
4
|
|
WBC count
|
< 15,000 per µL
|
0
|
|
|
15,000 to 25,000
|
1
|
|
|
> 25,000 per µL
|
2
|
|
erythrocyte count
|
>= 4 * 10^6/L
|
0
|
|
|
< 4 * 10^6/L
|
1
|
|
hemoglobin
|
> 13.5 g/dL
|
0
|
|
|
11.0 to 13.5 g/dL
|
1
|
|
|
< 11.0 g/dL
|
2
|
|
serum creatinine
|
<= 135 µmol/L
|
0
|
|
|
> 135 µmol/L
|
2
|
|
plasma fibrinogen
|
<= 750 mg/dL
|
0
|
|
|
> 750 mg/dL
|
2
|
|
pain
|
none or mild
|
0
|
|
|
moderate
|
1
|
|
|
severe
|
2
|
|
body temperature
|
<= 37.5°C
|
0
|
|
|
37.6 to 37.9°C
|
1
|
|
|
>= 38°C
|
2
|
|
heart rate
|
<= 100 beats per minute
|
0
|
|
|
> 100 beats per minute
|
1
|
|
signs of acute renal injury
|
no
|
0
|
|
|
yes
|
1
|
where:
• The original table showed errors in the WBC count and creatinine.
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 19
• The higher the score the greater the risk of necrotizing fasciitis.
|
Score
|
Necrotizing Fasciitis
|
|
0 to 5
|
unlikely
|
|
6 or 7
|
suspicious
|
|
8 to 19
|
strong suspicion
|
Performance:
• The positive predictive value for strong suspicion was 0.80 with negative predictive value of 0.91.
