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Infectious disease / surgery

LRINEC Score

The LRINEC score uses six laboratory values to differentiate necrotizing soft tissue infection from less severe cellulitis. Enter the most recent laboratory results to obtain the risk category.

mg/L

Points: 4

x10^3/uL

Points: 1

g/dL

Points: 1

mmol/L

Points: 2

mg/dL

Points: 2

mg/dL

Points: 1

Component points

  • CRP4
  • WBC1
  • Hemoglobin1
  • Sodium2
  • Creatinine2
  • Glucose1

Total LRINEC score

11

Range 0-13

High risk - Necrotizing fasciitis likely

Scores 8-13 have high positive predictive value. Urgent surgical consultation and broad-spectrum antibiotics are warranted.

LRINEC is a supportive tool; clinical suspicion should trigger emergent surgical evaluation regardless of score.

How to Use This Calculator

1

Collect current laboratory data

Use the most recent lab results. Ideally, all measurements should be from the same blood draw.

2

Enter values into the calculator

The tool automatically assigns points using the original LRINEC scoring thresholds.

3

Act on persistent clinical concern

Even low scores warrant urgent action if clinical features (rapid progression, pain out of proportion) suggest necrotizing fasciitis.

Formula

  • CRP ≥150 mg/L: 4 points
  • WBC 15-25 x10^3/uL: 1 point; >25 x10^3/uL: 2 points
  • Hemoglobin 11-13.5 g/dL: 1 point; <11 g/dL: 2 points
  • Sodium <135 mmol/L: 2 points
  • Creatinine >1.6 mg/dL: 2 points
  • Glucose >180 mg/dL: 1 point

Total score ranges from 0 to 13.

Full Description

The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score was developed to distinguish necrotizing soft tissue infections from severe cellulitis using routine laboratory values. High scores correlate with higher likelihood of necrotizing fasciitis and worse outcomes, supporting early aggressive management.

Limitations: sensitivity is modest, especially early in disease, and comorbidities (diabetes, chronic kidney disease) can elevate scores. Use LRINEC alongside clinical findings, imaging, and surgical consultation. False reassurance from low scores is a known pitfall.

Frequently Asked Questions

Does LRINEC replace surgical exploration?

No. Surgical evaluation remains the gold standard. LRINEC helps prioritize but does not confirm or exclude necrotizing fasciitis.

What if some labs are missing?

Obtain all six values whenever possible. Omitted parameters may underestimate risk. If unavailable, use clinical judgement.

Should LRINEC be repeated?

Yes. Rising scores or worsening labs support concern for a progressive necrotizing process.

Does the score apply to children?

LRINEC was validated in adults. Pediatric performance is uncertain; use pediatric-specific evidence and consult specialists.