Gopi Tupkar1, Mohammed Imran Khaleel2
BACKGROUND
Necroti
s ing Fasciitis (NF) is a fastly progressing infection of the fascia with the secondary involvement of skin which causes
inflammation of skin, subcutaneous tissues and muscle. NF is a life threatening surgical emergency . W e added the term medical
emergency as it requires emergent and aggressive medical care as most of these patients are treated in the intensive care uni t.
Various terminologies are used to describe Necroti s ing Fasciitis (NF) such as streptococcal gangrene, h ospital gangrene, acute
dermal gangrene, Fournier’s gangrene suppurative fasciitis and synergistic necroti s ing cellulitis.
The aim of the study is t
o evaluate the role of LRINEC score as a prognostic tool in patients with n ecrotising fasciitis
MATERIALS AND METHODS
This study is a prospective study collected from patients who were admitted in surgical intensive care unit, Department of
General Surgery, of Nizam’s Institute of Medical Sciences, Hyderabad, with a diagnosis of necrotising fasciitis was perfo rmed
provisionally irrespective of sex, age and ethnicity. Total 300 patients were included in the study who were suspected to hav e
necrotising fasciitis and L R INEC score were calculated at the time of admission to our institute. Based on L R INEC scoring,
p atients having score <6 were included in Group A, 150 patients and >6 were included in Group B, 150 patients. This study
was conducted in a period of August 2016 to September 2017.
Exclusion Criteria
Cases with irrelevant data and inaccurate diagnosis. Da ta collected included demographics, clinical
presentations, infection site, comorbidities type, microbiological and laboratory findings. Based on clinical and laboratory
assessments on arrival and during the hospital stay included criteria by the Center of Disease C ontrol and P revention and
National Necroti s ing Fasciitis Foundation and scoring, NF was diagnosed using this tool.
RESULTS
The site of infection in both the groups was highest in lower limbs
i.e. 45 in group A and 50 in group B. The site of infection
was least in chest and breast i.e. in group A it is 2 and in group B it is 3. The antibiotics used was ≤2, in group A it was 80
and in group B it was 85. >2 in group A, it was 20 and in gr oup B, it was 15. Mortality in % in group A was 18 and in group
B, it was 38. The laboratory results in which streptococcus microorganism was highest in both groups, in group A it was 50%
and in group B, it was 44%. Gram positive bacteria was the highes t comprising of 95% in group A and 99% in group B. The
causative bacteria was type II which comprised of 60% in each of group A and group B. C reactive protein level in group A was
121 ± 85 and in group B was 250 ± 101. Initial procalcitonin level in grou p A was 0.8 and in group B, it was 8.0. The mean
LRINEC score in group A was 3.5 ± 1.0 and in group B was 8.5 ± 2.0.
CONCLUSION
The high
risk patients and prediction of worst hospital outcomes in patients with NF were predicted by LRINEC scoring besides
its diagnostic role.
