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.
Specialty: Infectious Diseases, Clinical Laboratory, Surgery, general
