Fig 1.
Clinical presentation of patients with necrotizing fasciitis (NF) as compared to cellulitis.
All patient charts of 29 NF and 59 age- and gender matched patients with severe cellulitis were analysed retrospectively for various dermatological signs/descriptions of disease presentation, localization of disease, suspected etiology, and body temperature. All information is given in % of cases.
Fig 2.
‘Pain out of proportion’ is indicative for necrotizing fasciitis (NF), but not cellulitis.
Pain description in the patient charts of 29 NF and 59 age- and gender matched patients with severe cellulitis was scored as “mild/none”, “intermediate” or “strong”. A, al information is given in % of cases. B, Patients with NF or cellulitis were divided into the age groups indicated. Pain assessment for NF and cellulitis is depicted separately.
Fig 3.
Assessment of co-morbidities in NF and cellulitis patients.
A, The number of concomitant diseases was assessed for each case of NF (n = 29) and cellulitis (n = 59). B, For NF and cellulitis patients, the % of cases showing co-morbidities for each of the indicated diseases is shown. Statistical analyses using the binary logistic regression test revealed statistically significant differences for renal failure and chronic venous insufficiency. C, The body mass index was calculated for each patient. A+C, all data is shown as box plot.
Fig 4.
Laboratory findings in NF patients revealed significant signs of inflammation, renal failure and anaemia.
Laboratory investigations were performed in most cases of NF and erysipelas. A, All findings were analysed using PASW Statistics 18.0 (IBM SPSS Inc.) and the binary logistic regression test; data are shown as box plots. Normal values/ranges are depicted as dotted lines (for erythrocyte count, and hemoglobuline gender specific ranges are given). Statistical differences between NF and cellulitis patients are indicated (* = p≤0.05). B, Laboratory values for erythrocyte counts, hemoglobulin and CRP were split by age groups as indicated.
Fig 5.
Modifications of the laboratory risk indicator for necrotizing fasciitis (LRINEC) strongly improves its clinical value.
A, For a all 29 NF and 59 matched cellulitis patients, the LRINEC score was calculated. Results are shown as box plots. B-F, To improve its clinical relevance, several variations to the LRINEC sore have been introduced. In B, CRP levels were modified to 2 points (≥100 mg/dl) and 4 points (≥150). In C, sodium and glucose were exchanged for erythrocyte count (<4 x106/μl– 1 point) and fibrinogen levels (>750 mg/dl– 2 points). In D, alterations of B+C were combined. In E, clinically, immediately obvious parameters were added as follows: pain (strong– 2 points, intermediate– 1 point, mild/none– 0 points), fever (≥38°C– 2 points, 37.6–37.9°C– 1 point, ≤37.5°C– 0 points), tachycardia (>100 heart beats/minute– 1 point), and signs of renal failure (– 1 point). F, combination of D and E. For all variations, the scores were ranked as ‘no signs of NF’ (white), ‘suspicious’ (stripes), and ‘clear signs of NF’ (pink). At the bottom, sensitivity (sens.), specificity (spec.), positive and negative predictive values (PPV/NPV) of the (modified) scores are shown.
Table 1.
Modified LRINEC score with clinical symptoms.