Laboratory Risk Indicator for Necrotizing Fasciitis

Aka: Laboratory Risk Indicator for Necrotizing Fasciitis, LRINEC Score

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II. Indications

  1. Cellulitis (or other Skin and Soft Tissue Infection)
    1. Identify Necrotizing Fasciitis

III. Criteria (0 to 13 points total)

  1. C-Reactive Protein (C-RP)
    1. Score 0: C-RP <150 mg/L
    2. Score 4: C-RP >=150 mg/L
  2. Serum Creatinine
    1. Score 0: Creatinine <=1.6 mg/dl
    2. Score 2: Creatinine >1.6 mg/dl
  3. Blood Glucose
    1. Score 0: Glucose <=180 mg/dl
    2. Score 1: Glucose >180 mg/dl
  4. Hemoglobin (Hgb)
    1. Score 0: Hgb >13.5 g/dl
    2. Score 1: Hgb 11 to 13.5 g/dl
    3. Score 2: Hgb <11 g/dl
  5. Serum Sodium (sNa)
    1. Score 0: Sodium >= 135 mEq/L
    2. Score 2: Sodium < 135 mEq/L
  6. White Blood Cell Count (total WBC)
    1. Score 0: WBC <15,000/mm3
    2. Score 1: WBC 15,000 to 25,000/mm3
    3. Score 2: WBC >25,000/mm3

IV. Interpretation

  1. Total Score >6
    1. Consistent with Necrotizing Fasciitis
    2. Test Sensitivity: 68-90%
    3. Test Specificity: 85-95%
  2. Total Score >8
    1. Highly predictive of Necrotizing Fasciitis

V. Precautions

  1. Normal LRINEC Score does not exclude Necrotizing Fasciitis

VI. References

  1. Fernando (2019) Ann Surg 269(1):58-65 [PubMed]
  2. Wong (2004) Crit Care Med 32(7): 1535-41 +PMID:15241098 [PubMed]

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