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  1. WBC and Hemoglobin Point Functions

    WBC and Hemoglobin Point Functions: LRINEC ์ ์ˆ˜ ๊ณ„์‚ฐ๊ธฐ

    Tiered point assignment for White Blood Cell count and Hemoglobin used inside the total score.

๊ด‘๊ณ 

๊ฒฐ๊ณผ

LRINEC ์ ์ˆ˜
11
13์  ๋งŒ์ 
ํ•ญ๋ชฉ ์ ์ˆ˜
C-๋ฐ˜์‘์„ฑ ๋‹จ๋ฐฑ 4
๋ฐฑํ˜ˆ๊ตฌ ์ˆ˜ 1
ํ—ค๋ชจ๊ธ€๋กœ๋นˆ 1
๋‚˜ํŠธ๋ฅจ 2
ํฌ๋ ˆ์•„ํ‹ฐ๋‹Œ 2
ํ˜ˆ๋‹น 1

Risk: score โ‰ค5 low (<50%), 6โ€“7 intermediate (50โ€“75%), โ‰ฅ8 high (>75%). This tool supportsโ€”but does not replaceโ€”clinical judgment.

LRINEC ์ ์ˆ˜๋ž€?

LRINEC ์ ์ˆ˜(Laboratory Risk Indicator for Necrotizing Fasciitis)๋Š” Wong ๋“ฑ(2004)์ด ๊ฐœ๋ฐœํ•œ ์ž„์ƒ ์ ์ˆ˜ ์ฒด๊ณ„๋กœ, ๊ดด์‚ฌ์„ฑ ๊ทผ๋ง‰์—ผ์„ ๋ด‰์™€์ง์—ผ์ด๋‚˜ ๋†์–‘ ๊ฐ™์€ ๋‹ค๋ฅธ ์ค‘์ฆ ์—ฐ์กฐ์ง ๊ฐ์—ผ๊ณผ ๊ตฌ๋ณ„ํ•˜๋Š” ๋ฐ ๋„์›€์„ ์ค๋‹ˆ๋‹ค. ์ผ์ƒ์ ์œผ๋กœ ์‹œํ–‰ํ•˜๋Š” 6๊ฐ€์ง€ ํ˜ˆ์•ก ๊ฒ€์‚ฌ ๊ฒฐ๊ณผ๋ฅผ 0์ ์—์„œ 13์ ๊นŒ์ง€์˜ ํ•˜๋‚˜์˜ ์ ์ˆ˜๋กœ ํ†ตํ•ฉํ•ฉ๋‹ˆ๋‹ค. ๊ดด์‚ฌ์„ฑ ๊ทผ๋ง‰์—ผ์€ ์ง„ํ–‰์ด ๋งค์šฐ ๋น ๋ฅด๊ณ  ์ƒ๋ช…์„ ์œ„ํ˜‘ํ•˜๊ธฐ ๋•Œ๋ฌธ์— ์กฐ๊ธฐ ์ธ์ง€๊ฐ€ ๋ฌด์—‡๋ณด๋‹ค ์ค‘์š”ํ•˜๋ฉฐ, LRINEC ์ ์ˆ˜๋Š” ์ž„์ƒ ํŒ๋‹จ์„ ๋ณด์™„ํ•˜๋Š” ๊ฐ๊ด€์ ์ธ ์ง€ํ‘œ๊ฐ€ ๋ฉ๋‹ˆ๋‹ค.

์ ์ˆ˜ ์ฒ™๋„๋ฅผ ๋”ฐ๋ผ ์ €์œ„ํ—˜, ์ค‘๊ฐ„์œ„ํ—˜, ๊ณ ์œ„ํ—˜ ๊ตฌ๊ฐ„์„ ๋ณด์—ฌ์ฃผ๋Š” ์œ„ํ—˜ ๋ถ„๋ฅ˜ ๋ง‰๋Œ€
LRINEC ์ ์ˆ˜๋Š” ํ™˜์ž๋ฅผ ๊ดด์‚ฌ์„ฑ ๊ทผ๋ง‰์—ผ์˜ ์ €์œ„ํ—˜, ์ค‘๊ฐ„์œ„ํ—˜, ๊ณ ์œ„ํ—˜์œผ๋กœ ๋ถ„๋ฅ˜ํ•ฉ๋‹ˆ๋‹ค.

๊ณ„์‚ฐ๊ธฐ ์‚ฌ์šฉ ๋ฐฉ๋ฒ•

ํ™˜์ž์˜ ๊ฐ€์žฅ ์ตœ๊ทผ ๊ฒ€์‚ฌ๊ฐ’์„ ์ž…๋ ฅํ•˜์„ธ์š”. C-๋ฐ˜์‘์„ฑ ๋‹จ๋ฐฑ(CRP, mg/L), ๋ฐฑํ˜ˆ๊ตฌ ์ˆ˜(ร—10โน/L), ํ—ค๋ชจ๊ธ€๋กœ๋นˆ(g/dL), ํ˜ˆ์ฒญ ๋‚˜ํŠธ๋ฅจ(mmol/L), ํฌ๋ ˆ์•„ํ‹ฐ๋‹Œ(ยตmol/L), ํ˜ˆ๋‹น(mmol/L)์ด ํ•„์š”ํ•ฉ๋‹ˆ๋‹ค. ๊ณ„์‚ฐ๊ธฐ๋Š” ๊ฐ ์ด์ƒ ์ˆ˜์น˜์— ์ ์ˆ˜๋ฅผ ๋ถ€์—ฌํ•˜๊ณ  ์ด๋ฅผ ํ•ฉ์‚ฐํ•ด ์ด์ ๊ณผ ์œ„ํ—˜ ๋“ฑ๊ธ‰์„ ํ•จ๊ป˜ ํ‘œ์‹œํ•ฉ๋‹ˆ๋‹ค.

๊ณต์‹ ์„ค๋ช…

์ ์ˆ˜๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™์ด ๋ฐฐ์ ๋ฉ๋‹ˆ๋‹ค. CRP โ‰ฅ150 mg/L = 4์ , ๋ฐฑํ˜ˆ๊ตฌ 15โ€“25 = 1์ , >25 = 2์ , ํ—ค๋ชจ๊ธ€๋กœ๋นˆ 11โ€“13.5 = 1์ , <11 = 2์ , ๋‚˜ํŠธ๋ฅจ <135 = 2์ , ํฌ๋ ˆ์•„ํ‹ฐ๋‹Œ >141 = 2์ , ํ˜ˆ๋‹น >10 = 1์ ์ž…๋‹ˆ๋‹ค. ์ด์ ์ด 6์  ์ด์ƒ์ด๋ฉด ์ฃผ์˜๊ฐ€ ํ•„์š”ํ•ฉ๋‹ˆ๋‹ค.

$$\text{LRINEC} = \underbrace{\big[\text{CRP}\!\ge\!150\big]\!\cdot\!4}_{\text{C-Reactive Protein}} + f_{\text{WBC}}\!\left(\text{WBC}\right) + f_{\text{Hb}}\!\left(\text{Hb}\right) + \big[\text{Na}\!<\!135\big]\!\cdot\!2 + \big[\text{Cr}\!>\!141\big]\!\cdot\!2 + \big[\text{Glucose}\!>\!10\big]\!\cdot\!1$$

$$f_{\text{WBC}} = \begin{cases} 2 & \text{WBC} > 25 \\ 1 & 15 \le \text{WBC} \le 25 \\ 0 & \text{otherwise} \end{cases} \qquad f_{\text{Hb}} = \begin{cases} 2 & \text{Hb} < 11 \\ 1 & 11 \le \text{Hb} \le 13.5 \\ 0 & \text{otherwise} \end{cases}$$

ํ•ด์„ ๊ธฐ์ค€์€ ๋‹ค์Œ๊ณผ ๊ฐ™์Šต๋‹ˆ๋‹ค. 5์  ์ดํ•˜๋Š” ์ €์œ„ํ—˜(ํ™•๋ฅ  <50%), 6โ€“7์ ์€ ์ค‘๋“ฑ๋„ ์œ„ํ—˜(50โ€“75%), 8์  ์ด์ƒ์€ ๊ณ ์œ„ํ—˜(>75%)์„ ์˜๋ฏธํ•ฉ๋‹ˆ๋‹ค.

6๊ฐœ์˜ ๊ฒ€์‚ฌ ํ•ญ๋ชฉ ์•„์ด์ฝ˜์ด ํ•˜๋‚˜์˜ ์ด์  ์ƒ์ž๋กœ ๋ชจ์ด๋Š” ๊ทธ๋ฆผ
6๊ฐœ์˜ ๊ฒ€์‚ฌ ํ•ญ๋ชฉ์„ ๊ฐ๊ฐ ์ ์ˆ˜ํ™”ํ•˜์—ฌ ํ•ฉ์‚ฐํ•ด LRINEC ์ด์ ์„ ์‚ฐ์ถœํ•ฉ๋‹ˆ๋‹ค.

๊ณ„์‚ฐ ์˜ˆ์‹œ

CRP 160, ๋ฐฑํ˜ˆ๊ตฌ 16, ํ—ค๋ชจ๊ธ€๋กœ๋นˆ 12, ๋‚˜ํŠธ๋ฅจ 134, ํฌ๋ ˆ์•„ํ‹ฐ๋‹Œ 150, ํ˜ˆ๋‹น 11์ธ ๊ฒฝ์šฐ๋ฅผ ์‚ดํŽด๋ณด๊ฒ ์Šต๋‹ˆ๋‹ค. CRP โ‰ฅ150 โ†’ 4์ , ๋ฐฑํ˜ˆ๊ตฌ 15โ€“25 โ†’ 1์ , ํ—ค๋ชจ๊ธ€๋กœ๋นˆ 11โ€“13.5 โ†’ 1์ , ๋‚˜ํŠธ๋ฅจ <135 โ†’ 2์ , ํฌ๋ ˆ์•„ํ‹ฐ๋‹Œ >141 โ†’ 2์ , ํ˜ˆ๋‹น >10 โ†’ 1์ ์ž…๋‹ˆ๋‹ค. ์ด์  =

$$4+1+1+2+2+1 = 11$$

11์ ์œผ๋กœ, ์ด ํ™˜์ž๋Š” ๊ณ ์œ„ํ—˜๊ตฐ์— ํ•ด๋‹นํ•ฉ๋‹ˆ๋‹ค.

์ž์ฃผ ๋ฌป๋Š” ์งˆ๋ฌธ

์ ์ˆ˜๊ฐ€ ๋‚ฎ์œผ๋ฉด ๊ดด์‚ฌ์„ฑ ๊ทผ๋ง‰์—ผ์„ ๋ฐฐ์ œํ•  ์ˆ˜ ์žˆ๋‚˜์š”? ์•„๋‹™๋‹ˆ๋‹ค. LRINEC ์ ์ˆ˜๊ฐ€ ๋‚ฎ๋‹ค๊ณ  ํ•ด์„œ ์ง„๋‹จ์„ ๋ฐฐ์ œํ•  ์ˆ˜๋Š” ์—†์Šต๋‹ˆ๋‹ค. ์ˆ˜์ˆ ์  ํƒ์ƒ‰์ด ์—ฌ์ „ํžˆ ํ‘œ์ค€ ์ง„๋‹จ๋ฒ•์ด๋ฉฐ, ์ž„์ƒ์ ์œผ๋กœ ๊ฐ•ํ•˜๊ฒŒ ์˜์‹ฌ๋œ๋‹ค๋ฉด ์ ์ˆ˜๋ณด๋‹ค ์ž„์ƒ ํŒ๋‹จ์ด ํ•ญ์ƒ ์šฐ์„ ํ•ฉ๋‹ˆ๋‹ค.

์–ด๋–ค ๋‹จ์œ„๋ฅผ ์‚ฌ์šฉํ•ด์•ผ ํ•˜๋‚˜์š”? ์›๋ž˜ ๊ฒ€์ฆ ์—ฐ๊ตฌ์™€ ๋™์ผํ•˜๊ฒŒ CRP๋Š” mg/L, ๋ฐฑํ˜ˆ๊ตฌ๋Š” ร—10โน/L, ํ—ค๋ชจ๊ธ€๋กœ๋นˆ์€ g/dL, ๋‚˜ํŠธ๋ฅจ๊ณผ ํ˜ˆ๋‹น์€ mmol/L, ํฌ๋ ˆ์•„ํ‹ฐ๋‹Œ์€ ยตmol/L ๋‹จ์œ„๋ฅผ ์‚ฌ์šฉํ•˜์„ธ์š”.

์ด ๋„๊ตฌ๊ฐ€ ์ง„๋ฃŒ๋ฅผ ๋Œ€์‹ ํ•  ์ˆ˜ ์žˆ๋‚˜์š”? ์•„๋‹™๋‹ˆ๋‹ค. ์ด ๊ณ„์‚ฐ๊ธฐ๋Š” ๊ต์œก ๋ฐ ์˜์‚ฌ๊ฒฐ์ • ๋ณด์กฐ ๋ชฉ์ ์œผ๋กœ๋งŒ ์‚ฌ์šฉ๋˜๋ฉฐ, ๋ฐ˜๋“œ์‹œ ์ž๊ฒฉ์„ ๊ฐ–์ถ˜ ์˜๋ฃŒ์ง„์ด ์ „์ฒด ์ž„์ƒ ์–‘์ƒ๊ณผ ํ•จ๊ป˜ ํ•ด์„ํ•ด์•ผ ํ•ฉ๋‹ˆ๋‹ค.

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