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LRINEC Score for Necrotizing Soft Tissue Infection
LRINEC Score
Estimates the likelihood of necrotizing fasciitis using common laboratory values
LRINEC Score for Necrotizing Soft Tissue Infection
LRINEC Score
Estimates the likelihood of necrotizing fasciitis using common laboratory values
Instructions
The LRINEC Score is used to assess the risk of necrotizing fasciitis (NF) in patients presenting with severe soft tissue infections. It combines routine laboratory values into a scoring system that helps clinicians distinguish necrotizing fasciitis from less severe infections. Patients are stratified into risk categories based on their total score, guiding further investigation and management.
Overview
When to use
Why use
Evidences
Interpretation
Score | Risk of Necrotizing Fasciitis |
<6 | Low Risk |
6–7 | Intermediate Risk |
≥8 | High Risk |
The LRINEC Score is a 6‑variable laboratory score (CRP, WBC, hemoglobin, sodium, creatinine, glucose) proposed to help distinguish necrotizing fasciitis (NF) from other soft‑tissue infections; while elevated scores may support suspicion, external validations show widely variable sensitivity, so a low score cannot exclude NF and clinical judgment with early surgical exploration remains essential.
https://pubmed.ncbi.nlm.nih.gov/15241098/
CRP, WBC, hemoglobin, sodium, creatinine, and glucose are categorized and summed (0–13 points); commonly cited risk bands are low (<6), intermediate (6–7), high (≥8).
https://www.ebmedicine.net/media_library/files/Calculated%20Decisions%20E0112%20LRINEC.pdf
Several cohorts report much lower sensitivity (often 36–77%) with specificities ~72–93%, indicating many confirmed NF cases present with LRINEC <6 and would be missed by relying on the score alone. Recent narrative reviews emphasize LRINEC’s modest sensitivity and advise against using it as a screening rule‑out test; instead, use it as one piece of data among clinical signs (pain out of proportion, rapidly progressive edema, bullae, crepitus), imaging, and bedside exploration when suspected.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12263807/
Overview
When to use
Why use
Evidences
The LRINEC Score was developed to provide clinicians with a simple, objective method of identifying necrotizing fasciitis early, when clinical features may be subtle and nonspecific. Necrotizing fasciitis is a rapidly progressive and life-threatening infection of the fascia and subcutaneous tissue that requires urgent surgical intervention. Delayed diagnosis is associated with very high morbidity and mortality, making timely recognition critical.
The score incorporates six commonly available laboratory parameters: C-reactive protein (CRP), white blood cell (WBC) count, hemoglobin, sodium, creatinine, and glucose. Each parameter is assigned points based on thresholds, and the total score categorizes patients into low, intermediate, or high risk for necrotizing fasciitis.
While the LRINEC Score is valued for its ability to use routine labs to flag high-risk patients, it has limitations. Studies have shown variability in sensitivity and specificity, particularly in early disease stages where laboratory abnormalities may be minimal. Therefore, the score should not be used in isolation but rather as a supplement to clinical judgment, imaging, and surgical consultation.
Overview
When to use
Why use
Evidences
Interpretation
Score | Risk of Necrotizing Fasciitis |
<6 | Low Risk |
6–7 | Intermediate Risk |
≥8 | High Risk |
The LRINEC Score is a 6‑variable laboratory score (CRP, WBC, hemoglobin, sodium, creatinine, glucose) proposed to help distinguish necrotizing fasciitis (NF) from other soft‑tissue infections; while elevated scores may support suspicion, external validations show widely variable sensitivity, so a low score cannot exclude NF and clinical judgment with early surgical exploration remains essential.
https://pubmed.ncbi.nlm.nih.gov/15241098/
CRP, WBC, hemoglobin, sodium, creatinine, and glucose are categorized and summed (0–13 points); commonly cited risk bands are low (<6), intermediate (6–7), high (≥8).
https://www.ebmedicine.net/media_library/files/Calculated%20Decisions%20E0112%20LRINEC.pdf
Several cohorts report much lower sensitivity (often 36–77%) with specificities ~72–93%, indicating many confirmed NF cases present with LRINEC <6 and would be missed by relying on the score alone. Recent narrative reviews emphasize LRINEC’s modest sensitivity and advise against using it as a screening rule‑out test; instead, use it as one piece of data among clinical signs (pain out of proportion, rapidly progressive edema, bullae, crepitus), imaging, and bedside exploration when suspected.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12263807/
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