Laboratory risk indicator for necrotizing fasciitis (lrinec) score – as a tool for differentiating necrotizing fasciitis from other soft tissue infections

Background The primary objective is to evaluate LRINEC (laboratory risk indicator for necrotizing fasciitis ) as a tool for differentiating necrotizing fasciitis from other soft tissue infections in patients presenting with soft tissue infections admitted to the surgical wards in Coimbatore Medical college hospital and the secondary objectives in my study are 1) to predict the amputation rate and mortality rate in high risk patients 2) to know the incidence of necrotizing fasciitis in patients with comorbid conditions like diabetes. Study design prospective study Materials and methods Sample size of 144 patients who were presented with soft tissue infections admitted to the surgical wards in Coimbatore medical college hospital were studied.We have included the patients above 18 years of age and the excluded patients were age below 18 years and pregnant patients The patients details were collected and the comorbid factors were noted. Vitals were recorded . The blood parameters which are the parameters of LRINEC Score were collected by taking the blood sample and the reports were collected and tabulated. According to the score ,patients were categorized into low risk, intermediate risk and high risk patients .Pus culture and sensitivity were taken and reports were collected and analysed. Interventional Methods were undergone to the patients according to the risk criteria and they were also recorded.The outcome of the patient was also recorded individually. Tissue biopsy was also sent for confirming the necrotizing fasciitis and collected results After collecting and analysed the data statistically ,almost high risk patients were positive for necrotizing fasciitis as confirmed by tissue biopsy. And the intermediate groups are having the chance of progression of infection into necrotising fasciitis and the low risk patients were not having the chance of necrotizing fasciitis. Among the comorbidities, we have analyzed that the diabetes is the most common predisposing factor for Necrotizing fasciitis. Bacteriological studies were done by the growth of the organism present in the pus culture and sensitivity report data and the patients were treated with the appropriate sensitive antibiotics. The mortality and the amputation rate which was done to prevent the generalised septicaemia and mortality is higher among the high risk score group patients. By this score we were able to diagnose the NF patients earlier .The outcome among the high risk group is 80 % of the patients were saved either by doing the successive debridement and amputation to prevent sepsis induced mortality and 20% 0r less number of patients were died even with our aggressive treatment Conclusion LRINEC scoring system has a better positive predictive value in identifying the onset of necrotizing fasciitis and risk strategizing of the patients with severe soft tissue infections. The statistically significant association between the diabetes mellitus and the severity of risk is also noted. The laboratory investigations that are readily available are only included in the LRINEC score and thereby it helps in distinguishing between the necrotizing fasciitis and the soft tissue infections. Finally ,Laboratory risk Indicator for necrotizing fasciitis (LRINEC) score can be used as an adjuvant in the management of soft tissue infections and We can diagnose the Necrotizing fasciitis earlier by this score and the delay in treatment of the patients can be avoided. The prognosis of the patient can also be assessed