Prognostic Value of the LRINEC Score in Predicting Mortality and Limb Loss among Patients with Necrotizing Fasciitis: A Prospective Study at Reference Tertiary Hospital of Hodeidah, Yemen

الملخص

Background: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score distinguishes necrotizing fasciitis (NF) from other soft-tissue infections using admission laboratory values. However, its prognostic utility for predicting clinical deterioration, tissue destruction, and mortality remains debated, particularly in resource-limited emergency surgical settings with complex patient presentations. Objective : The purpose of this research is to evaluate the LRINEC score in for predicting the mortality and limb loss among patients with NF.  Methodology: This prospective observational study evaluated 100 consecutive patients with intraoperatively confirmed necrotizing fasciitis at a tertiary referral hospital in Hodeidah, Yemen. The demographics, clinical characteristics, and LRINEC components were recorded at admission. Adverse outcomes were tracked throughout hospitalization. Predictive accuracy was assessed via cross-tabulation, diagnostic metrics and receiver operating characteristic (ROC) curve analysis. Also, the multivariable logistic regression was used in this study. Results: The results showed that predominantly male (85.0%, n=85) with a mean age of 46.15±21.12 years. Lower extremities were the primary infection site in 75.0% of cases. The mean LRINEC score was 8.78±3.99, with 76.0% (n=76) classified as high-risk (≥8). The major amputation rate was 40.0% (n=40), while inpatient mortality was 3.0% (n=3). Cross-tabulation showed no linear relationship between LRINEC risk strata and outcomes; amputation rates were 40.0% in the low-risk group versus 40.79% in the high-risk group. ROC analysis revealed poor discrimination for amputation (AUC=0.53) and mortality (AUC=0.35). In multivariable regression, the continuous LRINEC score showed no association with amputation (p=0.992, aOR=0.999) or mortality (p=0.968, aOR=1.008). Chronic comorbidities—particularly Type II Diabetes Mellitus—were sole independent predictor of limb loss, nearly tripling amputation risk (p=0.046, aOR=2.959, 95% CI: 1.018–8.600). Conclusion: The admission LRINEC score reflects severe systemic inflammatory response but possesses poor prognostic value for mortality or limb loss in necrotizing fasciitis. Adverse outcomes are driven by physiological reserves and pre-existing vasculopathy rather than laboratory risk stratification. Surgical teams should prioritize rapid clinical triage and immediate operative intervention over score-based thresholds to optimize survival and limb preservation in critically ill patients.