What are the Alternatives to the LRINEC Score in Identifying Necrotizing Soft Tissue Infections in the Emergency Department?

Year 2022, Volume: 4 Issue: 2, 41 - 46, 31.08.2022

Ayça Çalbay Atıf Bayramoğlu Erdem Karadeniz

https://doi.org/10.55994/ejcc.1135938

Abstract

Background: The emergency department (ED) is an dynamically high-risk setting. Our aim is to determine the blood parameters associated with necrotizing soft tissue infections (NSTI) to strengthen the LRINEC score.
Materials and methods: We analyzed 109 patients who were diagnosed with necrotizing soft tissue infection in the Urology, Dermatology, Plastic surgery and General Surgery clinics of Atatürk University between 2013 and 2016. In the same period, we matched 624 patients diagnosed with cellulitis as a control group.
Results: Of four defined clinic's records to Atatürk University Hospital in 2013 to 2016, 109 matched and 624 matched control records were abstracted. Diagnoses associated with the NSTIs were: gangrene (n=47), gas gangrene (n=7), Fournier's gangrene (n=44) and necrotizing fasciitis (n=11). In patients with Necrotizing Soft Tissue Infection, BUN (p=0,00), K (0,011), Neutrofil (p=0,013), Lenfosit (p=0,003), Htc (p=0,00), RDW (p=0,002), Plt (p=0,042), AST (p=0,00), ALT (p=0,00) and INR (p=0,003) values were found to be statistically significant in making the diagnosis.
Conclusion: BUN, K, Neutrofil, Lenfosit, Htc, RDW, Plt, AST, ALT and INR values measured from blood tests of patients diagnosed with NSTI can be used in distinctive diagnosis of Soft Tissue Infection (STI). Increased awareness of these values may improve Emergency Department (ED) decision making and prevent miss diagnose.

Keywords

Cellulitis, Gangrene, Gas gangrene, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), Necrotising fasciitis, Necrotising soft tissue infection (NSTI).

Supporting Institution

YOK

Project Number

YOK

Thanks

We would like to thank Atatürk University general surgery, urology, plastic surgery and emergency departments for their support to this article.

References

• Referans1 Çalbay A. Nekrotizan Fasiit. In: Köse A, Delice O, editors. Ortopedik Aciller. Ankara: Akademisyen Kitapevi; 2019. pp 341-349. ISBN: 978-605-258-394-4
• Referans2 Liu Y-M, Chi C-Y, Ho M-W, Chen C-M, Liao W-C, Ho C-M, et al. Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect. 2005 Dec;38(6):430–5
• Referans3 Wong C-H, Khin L-W, Heng K-S, Tan K-C, Low C-O. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004 Jul;32(7):1535–41
• Referans4 Al-Hindawi A, McGhee J, Lockey J, Vizcaychipi M.Validation of the laboratory risk indicator for necrotising fasciitis scoring system (LRINEC) in a Northern European population. J Plast Reconstr Aesthet Surg. 2017 Jan;70(1):141-143
• Referans5 Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect. 2010 Aug;75(4):249–57
• Referans6 Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014 Aug;51(8):344–62
• Referans7 Hussein QA, Anaya DA. Necrotizing soft tissue infections. Crit Care Clin. 2013 Oct;29(4):795–806
• Referans8 Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI (1995) Out-come prediction in patients with Fournier’s gangrene. J Urol 154(1):89–92
• Referans9 Bozkurt O, Sen V, Demir O, Esen A.Evaluation of the utility of different scoring systems (FGSI, LRINEC and NLR) in the management of Fournier's gangrene. Int Urol Nephrol. 2015 Feb;47(2):243-8
• Referans10 Sung Jin Park, Dong Heon Kim , Chang In Choi , Sung Pil Yun , Jae Hun Kim , Hyung Il Seo , Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years. Ann Surg Treat Res. 2016 Jul;91(1):45-50
• Referans11 Moore SA, Levy BH, Prematilake C, Dissanaike S. The Prediction Predicament: Rethinking Necrotizing Soft Tissue Infections Mortality. Surg Infect (Larchmt). 2015 Aug 10;10.1089/sur.2015.002
• Referans12 Kincius M, Telksnys T, Trumbeckas D, Jievaltas M, Milonas D. Evaluation of LRINEC Scale Feasibility for Predicting Outcomes of Fournier Gangrene. Surg Infect (Larchmt). 2016 Mar 29
• Referans13 Krieg A, Dizdar L, Verde PE, Knoefel WT. Predictors of mortality for necrotizing soft-tissue infections: a retrospective analysis of 64 cases. Langenbecks Arch Surg.2014 Mar;399(3):333–41
• Referans14 Keeley J, Kaji A, Kim D, Yan H, Putnam BA, Plurad D, et al.Predictors of mortality in necrotizing soft tissue infection.Am Surg. 2014 Oct;80(10):989–93
• Referans15 Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogenesis and treatment. Expert Rev Anti Infect Ther. 2005 Apr;3(2):279–94
• Referans16 Fugitt JB, Puckett ML, Quigley MM, Kerr SM: Necrotizing fasiitis, Radiographics 2004; 24: 1472-1476