OBSERVATIONAL STUDY FOR VALIDATION OF THE LABORATORY RISK INDICATORS FOR NECROTIZING FASCIITIS (LRINEC) SCORE FOR EARLY DIAGNOSIS OF NECROTIZING FASCIITIS.

Dr. Ravi Verma; Dr. Sharad Seth; Dr. Alok Ranjan; Dr. Om Kumar Sharma

Volume : VIII, Issue : II, February - 2019

OBSERVATIONAL STUDY FOR VALIDATION OF THE LABORATORY RISK INDICATORS FOR NECROTIZING FASCIITIS (LRINEC) SCORE FOR EARLY DIAGNOSIS OF NECROTIZING FASCIITIS.

Dr. Ravi Verma, Dr. Sharad Seth, Dr. Alok Ranjan, Dr. Om Kumar Sharma

Abstract :

INTRODUCTION: Necrotizing fasciitis (NF) is a soft tissue infection spreading along fascial planes with or without overlying cellulitis accompanied by severe systemic toxicity. 13 per million of the population is hospitalized worldwide each year for NF, Of these 20-30% die. Mortality rate could reach up to 100% in the absence of proper and timely diagnosis and treatment.It is a surgical emergency which requires immediate wide surgical deidement and patients need to be kept on oad-spectrum antibiotics, otherwise survival is difficult. The most widely adopted score as far as diagnosis is concerned is the laboratory risk indicator for necrotizing fasciitis (LRINEC) developed by Wong and colleagues in 2004. Scores ≥6 were found to have a 92% positive predictive value and a 96% negative predictive value, It also stratifies patients low(≤5), intermediate(6-7) and (≥8)high groups. AIM AND OBJECTIVE: To study validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for early diagnosis of necrotizing fasciitis. To describe the defining characteristics of necrotizing fasciitis (NF), emphasizing early diagnostic indications with the help of the following parameters: C-reactive protein, Total WBC count, Haemoglobin, Serum sodium, Serum creatinine, Blood glucose. METHOD: This was a prospective observational study which include all the patients of necrotizing fasciitis admitted to the surgical wards in Rohilkhand Medical College and Hospital from November 2016 to October 2017. RESULT: A total of 100 patients included in the study were in the age group of 18-70 years and were of both sexes. The mean age of patients was 43.5 � 16.2 yrs with a maximum number of patients in the 31-40 years(22%) and 51-60 years(23%) age groups. Necrotising fasciitis effected 81% male patients and 19% female patients. Incidence of necrotising fasciitis in patients of Diabetes Mellitus was 18% and in peripheral Vascular Disease 7%.The site of involvement in order of frequency was; Lower limb(51%), Perineal region(25%),Upper limb(13%), and Thigh(8%). Distribution of patients according to LRINEC score was as follows, HIGH risk score ≥8 was 46%, MODERATE risk score 6-7 was 28%, LOW risk score ≤5 was 26%. Biopsy confirmation of necrotising fasciitis in patients according to different LRINEC score was as follows, 26% patients belonged to the LOW risk group(≤5) LRINEC score and out of these 19.23% showed biopsy confirmation of necrotising fasciitis ,28% patients belonged to MODERATE risk group (6-7)LRINEC score out of these 92.85% showed biopsy confirmation of necrotising fasciitis,46% patients belongs to the HIGH risk group(≥8) LRINEC score and biopsy confirmation of necrotizing fasciitis was 100%. Mortality of patients (as per LRINEC score) was as follows: In LOW risk and MODERATE risk group all patients survived and their postoperative course was uneventful. 10% patients out of the 46% of patients belonging to the HIGH risk group(≥ 8)LRINEC score expired. CONCLUSION: The LRINEC score is an index that is capable of detecting early cases of necrotizing fasciitis and is simple enough for routine use. In patients with multiple comorbidities, the inflammatory response may be blunted and the score should be interpreted with caution. The LRINEC score is also an indicator of the severity of sepsis. Serial LRINEC score monitoring is helpful, and in many cases an increasing score despite oad-spectrum antibiotics is a valuable prognostic indicator.