Evaluación de la escala LRINEC para el diagnóstico de fascitis necrosante en una población latinoamericana.

A retrospective cohort study was conducted in hospitalized patients with skin and soft tissue infections in two high-complexity Colombian institutions between 2016 and 2021. Patients presenting with systemic inflammatory response signs were considered suspected cases of FN and were followed until FN was confirmed or ruled out through surgical description or pathology. The LRINEC score was calculated, and its diagnostic and operational performance was assessed using ROC curves. Results: Among 1,546 clinical records, 29 confirmed cases of FN and 106 suspected cases with FN ruled out were identified. The average LRINEC score in the FN group was 6 points. A score ≥6 points yielded a sensitivity of 62.07%, specificity of 71.7%, and an ROC curve of 0.67; the positive predictive value (PPV) was 37.5% and the negative predictive value (NPV) was 87.36% (positive likelihood ratio [LR+] of 2.19 and negative likelihood ratio [LR–] of 0.52). For a score ≥8 points, sensitivity was 34.48%, specificity 89.62%, and ROC curve 0.62; the PPV was 47.62% and the NPV 83.3% (LR+ of 3.32 and LR– of 0.73).
Conclusions: The diagnostic performance of the LRINEC score in the population studied was moderate and consistent with previous studies. Its greatest utility lies in ruling out the disease, given its high NPV for scores below 6.

本研究于2016年至2021年间，在哥伦比亚两家高复杂度医疗机构中开展了一项针对皮肤与软组织感染住院患者的回顾性队列研究。将出现全身炎症反应征象的患者判定为疑似坏死性筋膜炎（FN）病例，并对其进行随访，直至通过手术记录或病理检查确认或排除FN诊断。研究人员计算了所有受试者的LRINEC评分（Laboratory Risk Indicator for Necrotizing Fasciitis），并采用受试者工作特征曲线（Receiver Operating Characteristic curve，ROC）评估其诊断效能与临床操作性能。结果：在纳入分析的1546份临床病历中，共确认29例坏死性筋膜炎（FN）确诊病例，以及106例疑似病例且最终排除FN诊断。坏死性筋膜炎组患者的平均LRINEC评分为6分。当LRINEC评分≥6分时，其诊断敏感度为62.07%、特异度为71.7%，受试者工作特征曲线下面积为0.67；阳性预测值（Positive Predictive Value, PPV）为37.5%，阴性预测值（Negative Predictive Value, NPV）为87.36%（阳性似然比[LR+]为2.19，阴性似然比[LR–]为0.52）。当LRINEC评分≥8分时，其诊断敏感度为34.48%、特异度为89.62%，受试者工作特征曲线下面积为0.62；阳性预测值为47.62%，阴性预测值为83.3%（阳性似然比为3.32，阴性似然比为0.73）。结论：本研究人群中，LRINEC评分的诊断效能中等，与既往相关研究结果一致。鉴于评分低于6分时具有较高的阴性预测值，LRINEC评分的最大临床应用价值在于排除坏死性筋膜炎诊断。