{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:12:29Z","timestamp":1790284349305,"version":"4.1.0"},"reference-count":26,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Necrotizing soft tissue infections (NSTIs) remain a significant source of in-hospital morbidity and mortality in the U.S. and around the world, yet the need for a reliable tool to assess prognosis early in treatment remains unaddressed in the current medical literature. Many scoring systems have been developed; however, none have proven to be entirely reliable for use in patients with NSTIs. Methods: Using collected data through a PubMed and Google Scholar search, this review provides an overview of five scoring systems\u2014LRINEC, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), NECROSIS, and POTTER\u2014while highlighting potential areas for further improvement of these scoring systems or the conception of a novel, more effective system. Results: The most widely used scoring tool, the Laboratory Risk Indicator for Necrotizing Fasciitis Score (LRINEC), lacks high sensitivity and requires supplementation of other clinical parameters. The NECROSIS score offers a potentially improved system, though it lacks necessary external validation. NLR and PLR provide reliable measurements for immune response; however, they lack specificity for NSTI and require further research to determine parameters like cutoff values. The POTTER score, though not valid for use in patients with NSTI, poses a novel system utilizing AI technology and machine learning. Conclusions: This review concludes that further development of a reliable scoring system that accounts for the many factors involved in NSTI is required and may benefit from an integrative model like the POTTER score.<\/jats:p>","DOI":"10.3390\/jcm14134550","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T03:33:25Z","timestamp":1750995205000},"page":"4550","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Predictive Models for Necrotizing Soft Tissue Infections: Are the Available Scores Trustable?"],"prefix":"10.3390","volume":"14","author":[{"given":"Sophie","family":"Tran","sequence":"first","affiliation":[{"name":"School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry J.","family":"Pullano","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3032-5880","authenticated-orcid":false,"given":"Sharon","family":"Henry","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9826-4722","authenticated-orcid":false,"suffix":"Jr.","given":"Marcelo A. F.","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1001\/jamasurg.2024.3365","article-title":"Necrotizing Soft Tissue Infections: A Review","volume":"159","author":"McDermott","year":"2024","journal-title":"JAMA Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1067\/j.cpsurg.2014.06.001","article-title":"Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes","volume":"51","author":"Hakkarainen","year":"2014","journal-title":"Curr. Probl. Surg."},{"key":"ref_3","first-page":"981","article-title":"Necrotizing fasciitis","volume":"55","author":"Puvanendran","year":"2009","journal-title":"Can. Fam. Physician"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.ijsu.2007.07.001","article-title":"Microbiology and management of soft tissue and muscle infections","volume":"6","author":"Brook","year":"2008","journal-title":"Int. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1002\/bjs.9371","article-title":"Early diagnosis of necrotizing fasciitis","volume":"101","author":"Goh","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev-pathol-121808-102135","article-title":"Molecular pathogenesis of necrotizing fasciitis","volume":"5","author":"Olsen","year":"2010","journal-title":"Annu. Rev. Pathol. Mech. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1089\/sur.2020.099","article-title":"Estimating the Impact of Necrotizing Soft Tissue Infections in the United States: Incidence and Re-Admissions","volume":"22","author":"May","year":"2021","journal-title":"Surg. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/TA.0000000000004351","article-title":"Current diagnosis and management of necrotizing soft tissue infections: What you need to know","volume":"97","author":"Bisgaard","year":"2024","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1097\/01.CCM.0000129486.35458.7D","article-title":"The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections","volume":"32","author":"Wong","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12245-018-0183-x","article-title":"Necrotising fasciitis: A fatal case of sepsis and a diagnostic challenge\u2014Case report and review of literature","volume":"11","author":"Agarwal","year":"2018","journal-title":"Int. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hoesl, V., Kempa, S., Prantl, L., Ochsenbauer, K., Hoesl, J., Kehrer, A., and Bosselmann, T. (2022). The LRINEC Score\u2014An Indicator for the Course and Prognosis of Necrotizing Fasciitis?. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133583"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1308\/rcsann.2017.0053","article-title":"Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: A systematic review of the literature","volume":"99","author":"Bechar","year":"2017","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1093\/gastro\/gox029","article-title":"A comparison of APACHE II, BISAP, Ranson\u2019s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification","volume":"6","year":"2018","journal-title":"Gastroenterol. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3861","DOI":"10.2147\/IDR.S413126","article-title":"Is Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio or Red Blood Cell Distribution Width Associated with Risk of Mortality in Patients with Necrotizing Fasciitis","volume":"16","author":"Wu","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Buonacera, A., Stancanelli, B., Colaci, M., and Malatino, L. (2022). Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23073636"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/iju.iju_256_22","article-title":"Comparison Between Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio As Predictors of Mortality on Fournier\u2019s Gangrene Cases","volume":"39","author":"Wirjopranoto","year":"2023","journal-title":"Indian J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s12262-019-01929-w","article-title":"Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Versus Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) as Predictors of Outcome in Necrotising Fasciitis","volume":"82","author":"Ravindhran","year":"2020","journal-title":"Indian J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1097\/TA.0000000000004374","article-title":"Prospective derivation and validation of a necrotizing soft tissue infections score: An EASTmulticenter trial","volume":"97","author":"Kim","year":"2024","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.jamcollsurg.2021.02.009","article-title":"Validation of the Artificial Intelligence-Based Predictive Optimal Trees in Emergency Surgery Risk (POTTER) Calculator in Emergency General Surgery and Emergency Laparotomy Patients","volume":"232","author":"Maurer","year":"2021","journal-title":"J. Am. Coll. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/SLA.0000000000002956","article-title":"Surgical Risk Is Not Linear: Derivation and Validation of a Novel, User-friendly, and Machine-learning-based Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) Calculator","volume":"268","author":"Bertsimas","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_21","first-page":"e20233624","article-title":"The use of POTTER (Predictive Optimal Trees in Emergency Surgery Risk) calculator to predict mortality and complications in patients submitted to Emergency Surgery","volume":"50","author":"Smaniotto","year":"2023","journal-title":"Rev. Col\u00e9gio Bras. Cir."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1016\/j.jamcollsurg.2021.08.152","article-title":"Application of the Predictive Optimal Trees in Emergency Surgery Risk Calculator (POTTER) to Emergency Surgical Debridement for Necrotizing Skin and Soft Tissue Infection","volume":"233","author":"Lawrence","year":"2021","journal-title":"J. Am. Coll. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/1346-8138.17663","article-title":"Validation of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and establishment of novel score in Japanese patients with necrotizing fasciitis (J-LRINEC score)","volume":"52","author":"Norimatsu","year":"2025","journal-title":"J. Dermatol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cheng, N.C., Tai, H.C., Chang, S.C., Chang, C.H., and Lai, H.S. (2015). Necrotizing fasciitis in patients with diabetes mellitus: Clinical characteristics and risk factors for mortality. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-1144-0"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e22.00106","DOI":"10.2106\/JBJS.OA.22.00106","article-title":"Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis","volume":"8","author":"Johnson","year":"2023","journal-title":"JBJS Open Access"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"012012","DOI":"10.1088\/1742-6596\/1142\/1\/012012","article-title":"Machine Learning from Theory to Algorithms: An Overview","volume":"1142","author":"Alzubi","year":"2018","journal-title":"J. Phys. Conf. Ser."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4550\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:59:28Z","timestamp":1760032768000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4550"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":26,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134550"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134550","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]}}}