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Hepatitis influences the diagnosis of Necrotising soft-tissue infection: A proposed modification to the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score from a retrospective study at a single institution

Published:August 20, 2020DOI:https://doi.org/10.1016/j.bjps.2020.08.027
      Necrotising soft-tissue infection (NSTI) is a life-threatening disease that is difficult to diagnose at early stages. Wong et al. reported that 76% of NSTI cases are misdiagnosed on admission.
      • Wong C.H.
      • Chang H.C.
      • Pasupathy S.
      • et al.
      Necrotizing fasciitis: clinical presentation, microbiology and determinants of mortality.
      The early diagnosis and debridement are essential in prognostic improvement. One previous study reported that a delay in surgery of more than 24 h made the mortality rate higher by 9.4 times.
      • Masjeski J.A.
      • Alexander J.W
      Early diagnosis, nutritional support and immediate extensive debridement improve survival in necrotizing fasciitis.
      The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score is a popular tool for the differentiation of NSTI from non-NSTI.
      • 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.
      However, the sensitivity of the LRINEC score differs from 68.2% to 100%.
      • Fernando S.M.
      • Tran A.
      • Cheng W.
      • et al.
      Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis.
      We hypothesized that NSTI patients with low LRINEC scores should have some comorbidities in common and this retrospective study aimed to specify those comorbidities and improve the LRINEC score.

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      References

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        Necrotizing fasciitis: clinical presentation, microbiology and determinants of mortality.
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