Laboratory Risk Indicator for Necrotizing Fasciitis of the Oro-Cervical Region (LRINEC-OC): A Possible Diagnostic Tool for Emergencies of the Oro-Cervical Region

Abstract

Aim. Oro-cervical necrotizing fasciitis (OCNF) treatment requires early surgical debridement and opening of the wound, and therefore, early diagnosis is very important. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score based on blood test data has recently been proposed as an auxiliary diagnostic tool. However, in some cases, it is difficult to diagnose OCNF. We performed a pooled analysis of patients with OCNF at Gunma University Hospital and literature cases, with the goal of designing a new auxiliary diagnostic tool for OCNF by adding physical characteristics of the oro-cervical region to blood test data in the first examination. Methods. Univariate and multivariate logistic regression was used to select predictors of OCNF. The LRINEC-Oro-Cervical (OC) score was then designed using correlation coefficients of items selected in logistic regression analysis. A cutoff value for the LRINEC-OC score was determined using receiver operating characteristic (ROC) curve analysis. Results. CRP, WBC, Cr, and skin flare in the cervical and precordial regions were extracted as independent factors (p<0.05) and evaluated as predictors of OCNF. The LRINEC-OC score for the prediction of OCNF was designed using the regression coefficients in logistic analysis. The cutoff value for the LRINEC-OC score was 6 points with a sensitivity of 88.5% and a specificity of 93.4%, and the AUC was 0.909. Conclusion. Delays in diagnosis and surgical treatment for OCNF led to a fatal prognosis, and the potential utility of the LRINEC-OC score for improving the prognosis was shown in this study.