Diagnostic performance of the LRINEC score for diagnosing necrotizing fasciitis in a Latin American population
DOI:
https://doi.org/10.15649/cuidarte.5497Keywords:
Fasciitis, Necrotizing, Cellulitis, Soft Tissue Infections, Forecasting, Sensitivity and SpecificityAbstract
Highlights
- The LRINEC score showed a high negative predictive value for diagnosing necrotizing fasciitis, helping to rule out the disease with scores lower than 6.
- In this Colombian cohort, the frequency of necrotizing fasciitis was 2.06% among patients hospitalized with skin and soft tissue infections.
- An LRINEC score ≥6 yielded 62% sensitivity and 72% specificity, whereas a score ≥8 showed lower sensitivity but higher specificity (90%).
- This is the first Colombian study evaluating the LRINEC score, showing diagnostic performance comparable to that reported in other Latin American populations.
Introduction: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed to estimate the likelihood of necrotizing fasciitis (NF); however, its diagnostic performance varies across populations, and evidence from Latin America remains limited. Objective: To assess the diagnostic performance of the LRINEC score in a Colombian population with skin and soft tissue infections. Materials and Methods: A retrospective cohort study was conducted among patients hospitalized at two tertiary care institutions in Colombia between 2016 and 2021. Patients with signs of systemic inflammatory response were considered suspected cases of NF. The diagnosis was confirmed or ruled out based on intraoperative or histopathologic findings. The LRINEC score was calculated, and its diagnostic performance was evaluated using sensitivity, specificity, and receiver operating characteristic (ROC) curves. Results: Among 1.546 medical records, 29 confirmed cases of NF and 106 suspected cases in which NF was ruled out were identified. The mean LRINEC score among patients with NF was 6 points. A cutoff score of ≥6 yielded a sensitivity of 62.07%, a specificity of 71.70%, and an area under the ROC curve (AUC) of 0.67. At a cutoff score of ≥8, sensitivity was 34.48%, and specificity was 89.62%. Discussion: These findings indicate moderate diagnostic performance, similar to that reported in other retrospective studies conducted in Latin American populations, with greater utility for ruling out NF than for ruling it in. Conclusions: The LRINEC score showed limited utility as a standalone diagnostic tool. A score <6 had a high negative predictive value and should always be interpreted in conjunction with clinical judgment.
How to cite this article: Arévalo Mojica Cristian David, Nocua-Báez Laura Cristina González Caicedo Paula Andrea, Meléndez Rhenals Sugeich del Mar, Saavedra Trujillo Carlos Humberto. Diagnostic performance of the LRINEC score for diagnosing necrotizing fasciitis in a Latin American population. Revista Cuidarte. 2026;17(3):e5497. https://doi.org/10.15649/cuidarte.5497
References
Chen LL, Fasolka B, Treacy C. Necrotizing fasciitis: A comprehensive review. Nursing. 2020;50(9):34-40. https://doi.org/10.1097/01.NURSE.0000694752.85118.62
van Stigt S, Knubben M, Schrooten T, Tan E. Prognostic factors for mortality in 123 severe cases of necrotizing fasciitis in 5 hospitals in the Netherlands between 2003 and 2017. European Journal of Trauma and Emergency Surgery. 2022;48(2):11891195. https://doi.org/10.1007/s00068-021-01706-z
Hadeed G, Smith J, O’Keeffe T, Kulvatunyou N, Wynne J, Joseph B, et al. Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience. Journal of Emergencies, Trauma, and Shock. 2016;9(1):22-27. https://doi.org/10.4103/0974-2700.173868
Zhang L-X, Liang Z-J, Zhao B-Y, Shi X-W, Zhang T, Liu H, et al. Delayed diagnosis and management of necrotizing fasciitis of the left lower leg: A case report. Medicine. 2022;101(43):e31231. https://doi.org/10.1097/MD.0000000000031231
Nawijn F, Smeeing DPJ, Houwert RM, Leenen LPH, Hietbrink F. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World Journal of Emergency Surgery. 2020;15(1):4. https://doi.org/10.1186/s13017-019-0286-6
Wong C-H, Khin L-W, Heng K-S, Tan K-C, Low C-O. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Critical Care Medicine. 2004;32(7):1535-1541. https://doi.org/10.1097/01.CCM.0000129486.35458.7D
Liao C-I, Lee Y-K, Su Y-C, Chuang C-H, Wong C-H. Validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for early diagnosis of necrotizing fasciitis. Tzu Chi Medical Journal. 2012;24(2):73-76. https://www.sciencedirect.com/science/article/pii/S1016319012000110
Gupta M, Aggarwal A, Singh H, Khazanchi RK, Mahendru S, Brajesh V, et al. Clinical and laboratory risk indicator for necrotizing fasciitis score in predicting the outcomes in necrotizing soft tissue infection patients. International Surgery Journal. 2020;7(6):1852-1856. https://doi.org/10.18203/2349-2902.isj20202395
Norimatsu Y, Fukasawa T, Ohno Y, Norimatsu Y, Matsuda KM, Hisamoto T, et al. Validation of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and establishment of novel score in Japanese patients with necrotizing fasciitis (J-LRINEC score). Journal of Dermatology. 2025;52(3):439–444. https://doi.org/10.1111/1346-8138.17663
Rodríguez-Roiz J. Serie de 41 casos de fascitis necrotizante en un hospital de tercer nivel. ¿Es tan mortal como pensamos? ¿Es útil hoy en día la escala LRINEC? Acta Ortop Mex. 2025;39(1):27–31. https://doi.org/10.35366/118849
Ferrer Lozano Y, Morejón Trofimova Y. Escala LRINEC en la Fascitis necrosante. ¿Una herramienta diagnóstica útil? Revista Habanera de Ciencias Médicas. 2018;17(2):236–243. https://www.redalyc.org/articulo.oa?id=180459978009
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology. 1996;49(12):1373–1379. https://doi.org/10.1016/S0895-4356(96)00236-3
Arévalo CD, Nocua Baez LC, González Caicedo PA, Meléndez Rhenals S del M, Saavedra Trujillo CH. “Evaluación de la escala LRINEC para el diagnóstico de fascitis necrosante en una población latinoamericana”. (2026). Mendeley Data, V2. https://doi.org/10.17632/wsghdf4hpd.1
Ministerio de Salud. Resolución número 8430 DE 1993. Santafé de Bogotá DC Colombia; 1993. Consulta: Mayo 12, 2025. Disponible en: https://www.redjurista.com/Documents/resolucion_8430_de_1993.aspx
Kiat H, En Natalie Y, Fatimah L. Necrotizing Fasciitis: How Reliable are the Cutaneous Signs? Journal of Emergencies, Trauma, and Shock. 2017;10(4):205-210. https://doi.org/10.4103/JETS.JETS_42_17
Breidung D, Malsagova AT, Barth AA, Megas IF, Billner M, Hitzl W, et al. Diagnostic and prognostic value of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) based on an 18 years experience. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2023;77:228–35. https://doi.org/10.1016/j.bjps.2022.11.061
Tarricone A, Mata KD La, Gee A, Axman W, Buricea C, Mandato MG, et al. A Systematic Review and Meta-Analysis of the Effectiveness of LRINEC Score for Predicting Upper and Lower Extremity Necrotizing Fasciitis. The Journal of Foot and Ankle Surgery. 2022;61(2):384–389. https://doi.org/10.1053/j.jfas.2021.09.015
Kim DH, Kim SW, Hwang SH. Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta-analysis. ANZ Journal of Surgery. 2022;92(7–8):1631–1637. https://doi.org/10.1111/ans.17459
Holland MJ. Application of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) Score to Patients in a Tropical Tertiary Referral Centre. Anaesthesia and Intensive Care. 2009;37(4):588–592. https://doi.org/10.1177/0310057X0903700416
Henry R, Matsushima K, Etzel M, Henry RN, Golden A, Wong V, et al. Utility of the Laboratory Risk Indicator for Necrotizing Fasciitis Score: Comorbid Conditions Do Matter. Surgical Infections. 2021;22(8):797–802. https://doi.org/10.1089/sur.2020.398
Tianyi FL, Mbanga CM, Danwang C, Agbor VN. Risk factors and complications of lower limb cellulitis in Africa: a systematic review. BMJ Open. 2018;8(7):e021175. https://doi.org/10.1136/bmjopen-2017-021175
Nawijn F, Smeeing DPJ, Houwert RM, Leenen LPH, Hietbrink F. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World Journal of Emergency Surgery. 2020;15:4. https://doi.org/10.1186/s13017-019-0286-6
Al-Qurayshi Z, Nichols RL, Killackey MT, Kandil E. Mortality Risk in Necrotizing Fasciitis: National Prevalence, Trend, and Burden. Surgical Infection. 2020;21(10):840–52. https://doi.org/10.1089/sur.2019.277
Chen Y, Huang Y, Shou J, Song R, Tan J, Deng J. Epidemiology and prognostic factors of necrotizing fasciitis in resource-limited regions based on 119 cases. Sci Rep. 2025;15:27458. https://doi.org/10.1038/s41598-025-13278-8
Bodansky DMS, Begaj I, Evison F, Webber M, Woodman CB, Tucker ON. A 16-year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England. World J. Surg. 2020;44(8):2580-2591. https://doi.org/10.1007/s00268-020-05559-2
Nguyen QD, Diab J, Khaicy D, Diab V, Hopkins Z, Foong LH, et al. Necrotising Fasciitis During the COVID-19 Pandemic: An Australian Hospital Network Experience. World J. Surg. 2023;47:1616-1630. https://doi.org/10.1007/s00268-023-07040-2
Hua C, Sbidian E, Hemery F, Decousser JW, Bosc R, Amathieu R, et al. Prognostic factors in necrotizing soft-tissue infections (NSTI): A cohort study. Journal of the American Academy of Dermatology. 2015;73(6):1006-1012. https://doi.org/10.1016/j.jaad.2015.08.054
Diab J, Bannan A, Pollitt T. Necrotising fasciitis. BMJ. 2020;369:m1428. http://www.bmj.com/content/369/bmj.m1428.abstract
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes. Current Problems in Surgery. 2014;51(8):344-362. https://doi.org/10.1067/j.cpsurg.2014.06.001
Shimizu T, Tokuda Y. Necrotizing Fasciitis. Internal Medicine. 2010;49(12):1051–1057. https://doi.org/10.2169/internalmedicine.49.2964
Frazee BW, Fee C, Lynn J, Wang R, Bostrom A, Hargis C, et al. Community-Acquired Necrotizing Soft Tissue Infections: A Review of 122 Cases Presenting to a Single Emergency Department Over 12 Years. Journal of Emergency Medicine. 2008;34(2):139–46. https://doi.org/10.1016/j.jemermed.2007.03.041
Zhou L, Li H, Luo G. Consensus on the Diagnosis and Treatment of Adult Necrotizing Fasciitis (2025 Edition). Burns & Trauma. 2025;13. https://doi.org/10.1093/burnst/tkaf031
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