Abstract

Necrotising fasciitis is a fatal and rapidly progressing soft tissue infection which requires early diagnosis and treatment to avoid morbidity and mortality, however cellulitis which presents similar in clinical presentation can be managed conservatively with IV antibiotics and supportive care and can avoid surgical debridement, hence LRINEC scoring suggested by Wong et al. was used earlier to differentiate and diagnose NF from cellulitis. In our study we studied serum PROCALCITONIN as a new and non-invasive marker to differentiate and diagnose NF from cellulitis, and also compared its efficacy with relation to LRINEC scoring system. We did a cross-sectional study on 35 patients including both NF and cellulitis. We used laboratory parameters like CBC, CRP, RFT, RBS and PROCALCITONIN when patient presented with soft tissue inflammation in emergency room and then patient was operated for surgical debridement and tissue was sent for tissue culture and histopathology. Patient was diagnosed as NF or cellulitis based on HPE report. And final diagnosis was compared with pre-operative PCT value and its sensitivity, specificity, PPV, NPV, cut-off value to diagnose NF was studied and also it was compared with LRINEC scoring system. In our study 46% were NF positive and 54% were diagnosed as cellulitis by HPE. 51% patients had PCT >2.6 ng/ml and majority were in high risk group according to LRINEC scoring system 85%. PCT showed 100% sensitivity and 84% specificity for NF with cut-of value of 2.4 ng/ml. Our study showed that pre-operative serum PCT can be used as a single and non-invasive marker to diagnose and differentiate NF from cellulitis as an alternative or in combination with LRINEC scoring system.

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