Necrotizing fasciitis (NF) is a rapidly progressing infection of the soft tissues
associated with high morbidity and mortality and hence it is a surgical emergency.
Early diagnosis and treatment are of paramount importance. LRINEC (Laboratory Risk
Indicator for Necrotizing Fasciitis) and SIARI (Site other than lower limb, Immunosuppression,
Age, Renal impairment, and Inflammatory markers) scoring systems have been established
for early and accurate diagnosis of necrotizing fasciitis. This study compared the
two scoring systems for diagnosing NF, predicting management, and elucidating the
prognostic performance for re-operation and mortality.
This prospective study was conducted in PGIMER Chandigarh, India, between February
2020 and June 2021. The study was approved by the Institutional Review Board (No.
INT/IEC/2020-90). The clinical presentation, laboratory parameters, and imaging were
used to classify patients into NF or severe cellulitis groups. We also calculated
the LRINEC and SIARI scores. Demographic variables and mortality were recorded. The
area under the receiver operating characteristic was used to express the accuracy
of both scores at a cut-off LRINEC and SIARI scores of ≥6 and ≥ 4, respectively.
The study comprised 41 patients with NF and 11 with severe cellulitis. Informed written
consent was taken from all the participants. At LRINEC score ≥6, the C-statistic for
NF diagnosis was 0.839 (95% confidence interval [CI] 0.682-0.995, P 0.001), which was better than SIARI score at ≥ 4, C-statistic of 0.608 (95% CI 0.43-0.787,
P 0.297). Both scores accurately predicted 30-day mortality. The LRINEC score showed
a C-statistic of 0.912 (95% CI 0.798-1, P 0.001). Simultaneously, the SIARI score showed 70% sensitivity and 77% specificity,
with a C-statistic of 0.805 (0.62-0.99, P = 0.017).
LRINEC score is an effective diagnostic tool for distinguishing necrotizing fasciitis
from severe cellulitis. Additional research is required to establish the SIARI score's