Role of LRINEC score in predicting mortality and limbloss in Necrotizing soft infections

Abstract

Background
Necrotizing soft tissue infections (NSTIs) are rapidly progressive fulminant infections involving soft tissue necrosis. It has a high mortality rate (ranging from 6 to 76%). There are different diagnostic adjuncts, such as finger tests, skin biopsies, ultrasounds and laboratory parameters to diagnose NSTI from other soft-tissue infections; one such modality is called LRINEC score – (Laboratory risk indicator for necrotizing fasciitis score), which predicts NSTI. A patient with an LRINEC score of 6 or more is considered at high risk of having NSTI.
Methods
A retrospective analysis was conducted for patients who were admitted with NSTI between August 2021 and September 2023. Based on LRINEC points, patients were classified into (Group 1: LRINEC < 9 and Group 2: LRINEC ≥ 9). The 2 groups were analysed and compared for mortality and limb loss.
Results
46 patients were enrolled into the study. There were 34 males and 12 females. The mean age of the study was 55.45 years. Diabetes mellitus was the most common co- morbidity, 30 cases - 65.2 %. The most common risk factor was smoking (47.8%). On analysing the clinical features of the group, 26.1% had tachypnea, 63% had tachycardia, and 43.4% had hypotension. Swelling, disproportionate pain, change in colour and temperature and tenderness were seen in all the patients enrolled (100%). Blisters were seen in 84.8%,skin necrosis in 89.1%, and ulceration was seen in 71.7% of the cases. On analysing clinical features and laboratory parameters of the
group with LRINEC score ≥9 and <9. we inferred that they were significantly associated with patients having an LRINEC score of more than 9.
Conclusions
LRINEC score ≥9 predicts mortality and amputation in patients with NSTI. Hence, patients with LRINEC score ≥ 9 need aggressive surgical intervention along with intensive care and attention.