title: Evaluation of LRINEC Scale Feasibility for Predicting Outcomes of Fournier Gangrene.
abstract: BACKGROUND
  Fournier gangrene (FG) is a fulminant necrotizing infection of the perineal, perianal, and periurethral tissues. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scale is used for diagnosis of necrotizing fasciitis. However, data on its relevance and usefulness in FG are lacking. The aim of this study was to evaluate the utility of the LRINEC scale in predicting the outcome of FG.
  
  
  METHODS
  This retrospective case study included 41 patents with FG treated at our institution from 2000 to 2013. The patients were divided into survivors and non-survivors.
  
  
  RESULTS
  The mortality rate was 22%. The median age (75 vs. 62.5 y; p = 0.013), rate of co-existing diabetes mellitus (66.7% vs. 3.1%; p < 0.001), and median affected skin surface (4% vs. 1%; p < 0.001) were greater in the non-survivors. Seven of nine patients (77.8%) who did not survive (compared with 37.5% who survived) had a polymicrobial infection (p = 0.032). Of all the causative pathogens isolated, Proteus mirabilis was more common in non-survivors (55.6% vs. 6.3%; p = 0.001). The median calculated LRINEC score for survivors was 5 compared with 10 for the non-survivors (p < 0.001). Regression analysis showed that all the aforementioned variables, except for polymicrobial culture, were significant risk factors for predicting death. The area under the receiver operating characteristic curve for the LRINEC score was the highest, 0.976 (95% confidence interval 0.872-0.999; p < 0.0001), and the cut-off value was ≥9 with 93.7% specificity and 100% susceptibility for the prediction of a lethal outcome.
  
  
  CONCLUSIONS
  The LRINEC score could be used for prediction of disease severity and outcomes. A threshold of 9 could be a high-value predictor of death during the initial evaluation of patients with FG.
authors.affiliation: 1 Department of Urology, Medical Academy, Lithuanian University of Health Sciences , Kaunas, Lithuania .
authors.forename: Marius
authors.initials: M
authors.lastname: Kincius
authors.affiliation: 2 Medical Academy, Lithuanian University of Health Sciences , Kaunas, Lithuania .
authors.forename: Titas
authors.initials: T
authors.lastname: Telksnys
authors.affiliation: 1 Department of Urology, Medical Academy, Lithuanian University of Health Sciences , Kaunas, Lithuania .
authors.forename: Darius
authors.initials: D
authors.lastname: Trumbeckas
authors.affiliation: 1 Department of Urology, Medical Academy, Lithuanian University of Health Sciences , Kaunas, Lithuania .
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Jievaltas
authors.affiliation: 1 Department of Urology, Medical Academy, Lithuanian University of Health Sciences , Kaunas, Lithuania .
authors.forename: Daimantas
authors.initials: D
authors.lastname: Milonas
mesh_terms: D000368:Aged; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000401:mortality*; D005240:Feasibility Studies; D018934:Fournier Gangrene / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index