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LRINEC Score for Necrotizing Soft Tissue Infection

LRINEC (Wong 2004) scores CRP, WBC, hemoglobin, sodium, creatinine and glucose (0–13) to flag necrotizing fasciitis. ≤5 low risk (<50% probability), 6–7 intermediate (50–75%), ≥8 high risk (>75%); a low score does not exclude the diagnosis.

C-reactive protein (mg/L or mg/dL)
White blood cell count (×10⁹/L or ×10³/µL)
Hemoglobin (g/dL or g/L)
Sodium (mmol/L or mEq/L)
Serum creatinine (mg/dL or µmol/L)
Glucose (mg/dL or mmol/L)

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Interpretation

Result	Meaning
≤ 5	Low risk (< 50%)
6–7	Intermediate risk (50–75%)
≥ 8	High risk (> 75%)

Formula

CRP ≥ 150 mg/L: 4 · WBC 15–25: 1, > 25 ×10⁹/L: 2 · Hb 11–13.5: 1, < 11 g/dL: 2 · Na < 135: 2 · creatinine > 1.6 mg/dL (141 µmol/L): 2 · glucose > 180 mg/dL (10 mmol/L): 1. Range 0–13.

Clinical pearls

External validations show much lower sensitivity than the derivation study (often 40–70% at ≥ 6); never use a low LRINEC to rule out necrotizing infection.
Necrotizing fasciitis is a surgical diagnosis: when suspected, get early surgical consultation rather than waiting for imaging or scores.

Examples

lrinec crp 200 wbc 20 hb 12 na 132 cr 1.8 glucose 200 necrotizing fasciitis score: CRP 90, WBC 14, Hgb 14, sodium 138, creatinine 80 umol/L, glucose 6 mmol/L nec fasc risk crp 250 wbc 28 hb 10.5

FAQ

What LRINEC score suggests necrotizing fasciitis?

A score ≥ 6 raises suspicion and ≥ 8 is strongly predictive (> 75% in the derivation cohort).

Can a low LRINEC rule out necrotizing fasciitis?

No. Sensitivity in later studies is poor, so clinical suspicion should prompt surgical exploration regardless of the score.

Evidence

Wong CH et al. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535–41.

Infectious Disease · Reviewed 2026-10-14 · Methodology