Abstract
This review and meta-analysis aims to assess the prognostic value of the Laboratory
Risk Indicator for Necrotizing Fasciitis (LRINEC) score for detecting necrotizing
fasciitis in the extremities. The LRINEC score has been validated in multiple studies
as a clinical tool for differentiating necrotizing fasciitis from non-necrotizing
infections however many studies do not specify the location of infection. As the prevalence
of diabetes and diabetic foot infections continues to rise, the utility of LRINEC
scores in these populations becomes of increased importance. Four databases were reviewed
for citations between January 2010 and December 2020. English, full text articles
reporting the diagnostic effects of LRINEC were utilized in the systematic review
portion of this paper. Further inclusion of 2 × 2 tables and discussion specific to
the extremities were applied for citations implemented in the meta-analysis. Of the
111 results, 12 citations (n = 932) were included in this review. The diagnostic sensitivity
of the LRINEC score ranged from 36% to 77% while specificity ranged from 72% to 93%.
Cumulative odds ratio for LRINEC ≥6 among the 4 studies assessing extremity necrotizing
fasciitis was 4.3 with p value of <.05. Sensitivity, specificity, positive predictive value, and negative
predictive value was 49.39%, 83.17%, 34.91%, and 89.99%, respectively. Accuracy, the
classification by whether a patient was correctly classified, was 77.95%. LRINEC score
is effective at distinguishing necrotizing fasciitis from other soft tissue infections
however the LRINEC's score greatest clinical application may be its ability to rule
out necrotizing fasciitis while its ability to accurately identify the presence of
infection remains suboptimal.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 18, 2021
Footnotes
Financial Disclosure: No financial support was received.
Conflict of Interest: All authors have no financial conflict of interest to report.
Identification
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© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
