title: The Laboratory Risk Indicator for Necrotizing Fasciitis score for discernment of necrotizing fasciitis originated from Vibrio vulnificus infections.
abstract: BACKGROUND
  The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been verified as a useful diagnostic tool for detecting necrotizing fasciitis (NF). Its application, however, is mainly for NF types I and II. The practical relevance of the LRINEC score for Vibro vulnificus-related skin and soft tissue infection (SSTI) was hardly ever investigated. The aim of this study was to assess the applicability of the LRINEC scoring system and to identify NF-predicting factors in patients with V. vulnificus-caused SSTI.
  
  
  METHODS
  A retrospective study was conducted, enrolling 125 consecutive patients diagnosed with V. vulnificus-related SSTI who were admitted to a teaching hospital between January 2003 and December 2011. Demographics, laboratory data, comorbidities, treatment, and outcomes were collected for each patient and extracted for analysis. Logistic regression and receiver operating characteristic curve analyses were performed.
  
  
  RESULTS
  The mean (SD) age of the 125 patients was 63.0 (10.9) years; 58% of the patients were male. The mean (SD) LRINEC score at admission was 2.4 (1.9) points. Of the 125 patents, 72 (58%) had NF. Multivariate analysis revealed that the presence of hemorrhagic bullous lesions (p = 0.002) and higher LRINEC scores at admission (p < 0.0001) were significantly associated with the presence of NF. In addition, the area under the receiver operating characteristic curve for the LRINEC scoring model for detecting NF was 0.783 (p < 0.0001). An optimal cutoff LRINEC score of 2 or greater had a sensitivity of 71%, a specificity of 83%, and a positive predictive value of 85%, with an 11.9-fold increased risk for the presence of NF (p < 0.0001).
  
  
  CONCLUSIONS
  We have demonstrated that the LRINEC score and hemorrhagic bullous/blistering lesions are significant predictors of NF in patients with V. vulnificus-related SSTI. V. vulnificus-infected patients having hemorrhagic bullous/blistering lesions or with an LRINEC score of 2 or greater should be thoughtfully evaluated for the presence of NF.
  
  
  METHODS
  Diagnostic test study, level II.
authors.affiliation: Institute of Medicine, School of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Wai-Nang
authors.initials: WN
authors.lastname: Chao
authors.forename: Shih-Jei
authors.initials: SJ
authors.lastname: Tsai
authors.forename: Chin-Feng
authors.initials: CF
authors.lastname: Tsai
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Su
authors.forename: Khee-Siang
authors.initials: KS
authors.lastname: Chan
authors.forename: Yuan-Ti
authors.initials: YT
authors.lastname: Lee
authors.forename: Kwo-Chang
authors.initials: KC
authors.lastname: Ueng
authors.forename: Ding-Bang
authors.initials: DB
authors.lastname: Lin
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Chen
authors.forename: Shiuan-Chih
authors.initials: SC
authors.lastname: Chen
mesh_terms: D003661:Decision Support Techniques; D019115:Fasciitis, Necrotizing / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D014735:Vibrio Infections / Q000175:diagnosis* / Q000473:pathology; D041261:Vibrio vulnificus