Prognostic value of the LRINEC score (Laboratory Risk Indicator for Necrotizing Fasciitis) in soft tissue infections: A prospective study at Clermont-Ferrand University Hospital

Background. - The LRINEC score was developed in a retrospective study in order to distinguish necrotizing fasciitis from severe soft tissue infections using laboratory data. Aim. - To evaluate the prognostic value of the LRINEC score in infectious cellulitis. Patients and methods. - A prospective study was performed at the departments of infectious diseases and dermatology of the Clermont-Ferrand University Hospital. The three evaluation criteria were: time from initiation of antibiotics to regression of erythema, duration of fever and occurrence of complications (abscess, surgery, septic shock, necrotizing fasciitis, death, transfer to intensive care). Potential predictive variables were: LRINEC score > 6 at admission, comorbidities, local appearance, clinical presentation and soft tissue ultrasound results. Results. - Fifty patients were included. The rate of complications was higher for patients with a LRINEC score > 6 (54%) than for patients with a score < 6 (12%, P=0.008). However, a LRINEC score > 6 on admission was not significantly associated with increased duration of erythema or of fever. Prior lymphoedema was associated with a better prognosis. Discussion. - The LRINEC score may be a useful toot for the detection of complicated forms of soft tissue infections. Patients with a LRINEC score > 6 on admission should be carefully evaluated (hospitalization, surgical assessment, close monitoring). (C) 2009 Published by Elsevier Masson SAS.