Necrotizing Soft-Tissue Infections
(2018) New England Journal of Medicine — Vol. 378, n° 10, p. 970-971 (2018)
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- (en) In their review article, Stevens and Bryant (Dec. 7 issue)1 discuss necrotizing soft-tissue infections. Early diagnosis is missed in 85 to 100% of cases.2 In Figure 2 of the article (available at NEJM.org), the authors propose an algorithm that is based on the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. However, Borschitz et al.3 found that serum sodium and glucose levels are of less value than the erythrocyte count and fibrinogen levels, which is why they proposed a modified LRINEC scoring system. They exchange the sodium and glucose levels for the erythrocyte count (1 point for a count of <4×106 per cubic millimeter) and fibrinogen level (2 points for a level of >750 mg per deciliter) — changes that result in an increase in the positive predictive value to 72%. Finally, the addition of clinical variables such as pain (2 points for severe pain, 1 point for intermediate pain, and 0 points for mild or no pain), fever (2 points for a temperature of ≥38.0°C, 1 point for 37.6 to 37.9°C, and 0 points for ≤37.5°C), tachycardia (1 point for a heart rate of >100 beats per minute), and signs of acute kidney injury (1 point) increases the positive predictive value to 80% and the negative predictive value to 91%. This modified scoring system seems to be more appropriate than the standard LRINEC scoring system and can lead to better disease outcomes by enabling rapid adequate therapy. [...]
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Yildiz, H., & Yombi, J. C. (2018). Necrotizing Soft-Tissue Infections. New England Journal of Medicine, 378(10), 970-971. https://doi.org/10.1056/nejmc1800049 (Original work published 2018)