The SIARI Score: A Novel Decision Support Tool Outperforms LRINEC Score in Necrotizing Fasciitis
The SIARI Score: A Novel Decision Support Tool Outperforms LRINEC Score in Necrotizing Fasciitis
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DOI：
10.1007/s00268-019-05061-4
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发表时间：
2019-10-01
影响因子：
2.6
通讯作者：
MacCormick, Andrew D.
中科院分区：
文献类型：
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作者：
Cribb, Benjamin I.;Wang, Michael T. M.;MacCormick, Andrew D.
背景坏死性筋膜炎实验室风险指标（LRINEC）评分系统旨在帮助诊断坏死性筋膜炎并指导治疗[1]。目的验证LRINEC评分并确定临床预测因素，以开发用于新西兰Middlemore医院诊断坏死性筋膜炎的精细诊断评分工具。方法这是一项回顾性病例对照研究，对象是2000年1月至2010年12月期间因坏死性筋膜炎和严重蜂窝织炎而入住米德尔莫尔医院的患者。评估入院时LRINEC评分在区分坏死性筋膜炎和严重蜂窝织炎病例方面的表现。病例和对照随机分为发育和验证队列。对诊断坏死性筋膜炎的人口统计学、临床和实验室变量进行单变量和多变量logistic回归分析。确定的独立预测因子用于开发新的诊断评分工具。结果LRINEC评分≥ 6分诊断坏死性筋膜炎的受试者工作特征曲线下面积（C统计量）为0.679。新开发的SIARI评分[下肢以外部位、免疫抑制、年龄< 60岁、肾损害（肌酐> 141）和炎症标志物（CRP >= 150，WCC > 25）在发育（C-统计：0.832对比0.691，p < 0.001）和验证组群（C-统计量：0.847对比0.667，p < 0.001）。结论LRINEC评分在该队列中仅表现出中等的区分性能，而SIARI评分是一种简化的工具，显示出检测坏死性筋膜炎的上级诊断能力。需要进行未来的外部验证研究，以确认本研究中观察到的趋势。
Background The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was developed to aid the diagnosis of necrotizing fasciitis and guide management [1]. Aim To validate the LRINEC score and identify clinical predictors to develop a refined diagnostic scoring tool for the diagnosis of necrotizing fasciitis at Middlemore Hospital, New Zealand. Methods This was a retrospective case-control study of patients admitted to Middlemore Hospital with necrotizing fasciitis and severe cellulitis between January 2000 and December 2010. The LRINEC scores at admission were evaluated for performance in discriminating between cases of necrotizing fasciitis and severe cellulitis. Cases and controls were randomized into developmental and validation cohorts. Univariate and multivariate logistic regression analysis of demographic, clinical, and laboratory variables for the diagnosis of necrotizing fasciitis was performed. The identified independent predictors were used to develop a new diagnostic scoring tool. Results The area under the receiver operating characteristic curve (C-statistic) of a LRINEC score >= 6 for the diagnosis of necrotizing fasciitis was 0.679. The newly developed SIARI score [Site other than the lower limb, Immunosuppression, Age < 60 years, Renal impairment (creatinine > 141), and Inflammatory markers (CRP >= 150, WCC > 25] demonstrated superior diagnostic ability compared with the LRINEC score in both the developmental (C-statistic: 0.832 vs. 0.691, p < 0.001) and validation cohorts (C-statistic: 0.847 vs. 0.667, p < 0.001). Conclusion The LRINEC score exhibited only modest discriminative performance in this cohort, while the SIARI score is a simplified tool that demonstrates superior diagnostic ability for detecting necrotizing fasciitis. Future external validation studies are required to confirm the trends observed in this study.