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Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections

Authors
  • Wu, Po-Han1
  • Wu, Kai-Hsiang1
  • Hsiao, Cheng-Ting1, 2
  • Wu, Shu-Ruei3
  • Chang, Chia-Peng1
  • 1 Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 613, Taiwan (R.O.C.) , Puzi City (Taiwan)
  • 2 Chang Gung University, Taoyuan, Taiwan , Taoyuan (Taiwan)
  • 3 Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan , Kaohsiung (Taiwan)
Type
Published Article
Journal
World Journal of Emergency Surgery
Publisher
Springer (Biomed Central Ltd.)
Publication Date
May 26, 2021
Volume
16
Issue
1
Identifiers
DOI: 10.1186/s13017-021-00373-0
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundWe conducted this study to promote a modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score and evaluate the utility in distinguishing necrotizing fasciitis (NF) from other soft-tissue infections.MethodA retrospective cohort study of hospitalized patients with NF diagnosed by surgical finding was conducted in two tertiary hospital in southern Taiwan between January 2015 and January 2020. Another group was matched by controls with non-necrotizing soft tissue infections based on time, demographics, and immune status. Data such as infectious location, comorbidities, and laboratory findings were recorded and compared. Logistics regression were used to determine the association with NF after adjustment for confounders and MLRINEC score was developed by then. Receiver operating curve (ROC) and the area under the curve (AUC) were used to evaluate its discriminating ability.ResultA total of 303 patients were included; 101 in NF group and 202 in non-NF group. We added serum lactate and comorbid liver disease to the original LRINEC score and re-defined the cut-off values for 3 variables to develop the MLRINEC score. The cut-off value for MLRINEC score was 12 points with corresponding sensitivity of 91.8% and a specificity of 88.4%, and the area under ROC (AUC) was 0.893 (95% CI, 0.723 to 0.948; p < 0.01).ConclusionMLRINEC score shows a high sensitivity and specificity in distinguishing NF from non-necrotizing soft-tissue infections. Patients with a MLRINEC score > 12 points should be highly suspected of presence of necrotizing fasciitis.

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