A PROSPECTIVE STUDY TO ASSESS THE DIAGNOSTIC EFFICACY OF LABORATORY RISK INDICATOR FOR NECROTIZING FASCIITIS (LRINEC) SCORING SYSTEM IN PATIENTS WITH SOFT TISSUE INFECTION

Abstract

Background Necrotizing fasciitis which is commonly known as “Flesh-Eating Disease” is an uncommon soft-tissue infection. It is characterized by widespread fascial necrosis with relative sparing of overlying skin and underlying muscle. Mostly it is associated with severe systemic toxicity and a fulminant course. It is usually rapidly fatal unless promptly recognized and aggressively treated with appropriate antimicrobials and surgical debridement at the earliest. Methods Our study was a prospective study conducted on 140 patients over a period of 2 years from June 2018 to June 2020 in a tertiary care hospital, GGH, Kadapa. All patients were selected randomly and evaluated by taking proper history, thorough clinical examination, routine laboratory investigations and histopathological examination of the debrided tissue and the outcomes were analysed to know the efficacy of LRINEC Scoring in diagonising necrotizing fasciitis. Results Most common age group was 41-50 years. Males were commonly affected, accounting to 74% i.e., 111 patients and the remaining 39 patients were females (39%). Fever, inflammation of the involved area were the most common presentations. Majority were diabetic and hypertensive accounting to 55.3% and 52.7% respectively. All patients presented with symptoms with swelling, redness, pain and induration. Eighty-one percent had elevated CRP. Total WBC count was raised in 78.7% of the cases. Fifty-six percent of the cases had haemoglobin less than 11g/dl. Hyponatremia was observed in 81.3% of the patients. Majority (52.7%) had normal sr. creatinine i.e., < or =1.4. RBS was elevated in 54.7% of the cases. In our study 87.3% of the patients had a LRINEC score >6. Histology was positive for necrotising fasciitis in 92% of the cases, among them majority had polymicrobial organisms on culture. Conclusion In patients with severe soft tissue infections, LRINEC scoring based on laboratory parameters is an easy and reliable diagnostic tool to diagnose Necrotizing fasciitis accurately.