title: The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role.
abstract: BACKGROUND
  Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to evaluate the prognostic value of LRINEC scoring in NF patients.
  
  
  METHODS
  A retrospective analysis was conducted for patients who were admitted with NF between 2000 and 2013. Based on LRINEC points, patients were classified into (Group 1: LRINEC < 6 and Group 2: LRINEC ≥ 6). The 2 groups were analyzed and compared. Primary outcomes were hospital length of stay, septic shock and hospital death.
  
  
  RESULTS
  A total of 294 NF cases were identified with a mean age 50.9 ± 15 years. When compared to Group1, patients in Group 2 were 5 years older (p = 0.009), more likely to have diabetes mellitus (61 vs 41%, p < 0.001), Pseudomonas aeruginosa infection (p = 0.004), greater Sequential Organ Failure Assessment (SOFA) score (11.5 ± 3 vs 8 ± 2, p = 0.001), and prolonged intensive care (median 7 vs 5 days) and hospital length of stay (22 vs 11 days, p = 0.001). Septic shock (37 vs. 15%, p = 0.001) and mortality (28.8 vs. 15.0%, p = 0.005) were also significantly higher in Group 2 patients. Using Receiver operating curve, cutoff LRINEC point for mortality was 8.5 with area under the curve of 0.64. Pearson correlation analysis showed a significant correlation between LRINEC and SOFA scorings (r = 0.51, p < 0.002).
  
  
  CONCLUSIONS
  Early diagnosis, simplified risk stratification and on-time management are vital to achieve better outcomes in patients with NF.
  
  
  CONCLUSIONS
  Beside its diagnostic role, LRINEC scoring could predict worse hospital outcomes in patients with NF and simply identify the high-risk patients. However, further prospective studies are needed to support this finding.
authors.affiliation: Clinical Medicine, Weill Cornell Medical School, Doha, Qatar. aymanco65@yahoo.com.|Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar. aymanco65@yahoo.com.|Weill Cornell medical college, Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar. aymanco65@yahoo.com.
authors.forename: Ayman
authors.identifier: http://orcid.org/0000-0003-2584-953X
authors.initials: A
authors.lastname: El-Menyar
authors.affiliation: Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Asim
authors.affiliation: Department of Surgery, Intensive Care Unit, HGH, Doha, Qatar.
authors.forename: Insolvisagan N
authors.initials: IN
authors.lastname: Mudali
authors.affiliation: Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar.
authors.forename: Ahammed
authors.initials: A
authors.lastname: Mekkodathil
authors.affiliation: Department of Surgery, Westchester Health, Valhalla, NY, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.affiliation: Department of Surgery, trauma Surgery, HGH, Doha, Qatar.
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D042241:Early Diagnosis; D019115:Fasciitis, Necrotizing / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: LRINEC score; Necrotizing fasciitis; Outcomes; Prognosis; SOFA score; Sepsis