Reconstructive UrologyFournier's Gangrene: Overview of Prognostic Factors and Definition of New Prognostic Parameter
Section snippets
Material and Methods
The medical records of 18 patients with FG who were treated and followed up from December 2006 to December 2008 in our clinic were reviewed. Data were collected in terms of medical history, symptoms, and physical examination findings. The biochemical, hematologic, and bacteriologic study (aerobic and anaeorobic wound cultures) results at admission and at the final evaluation, the physical examination findings, the timing and extent of surgical debridement, and the antibiotic therapy were also
Results
Of the 18 patients evaluated, 4 (22.2%) died and 14 (77.8%) survived. The overall median age was 57.0 years. The median admission time was 4 days and was similar between the survivors and nonsurvivors.
The patients were evaluated by the onset of symptoms. The first symptom had appeared in the scrotum in 12 survivors and 3 nonsurvivors, and it had appeared in the perineum in 2 survivors and 1 nonsurvivor. The median extent of the body surface area (TBSA%) involved in the necrotizing process in
Comment
In the present study, we demonstrated that a greater CCI and FGSI (>9), low magnesium levels, and other laboratory parameters, including hematocrit, hemoglobin, creatinine, ALP, might be prognostic factors and related mortality in patients with FG.
FG is a synergistic necrotizing fasciitis of the perineal, genital, and perianal region that leads to thrombosis of the small subcutaneous vessels and results in the development of gangrene of the overlying skin. It is an acute urologic emergency,
Conclusion
FG is an uncommon necrotizing fasciitis of the genitalia and perineum and has high mortality and morbidity. Hematocrit, hemoglobin, creatinine, ALP, TBSA%, heart and respiratory rates, rectal involvement, and diverting colostomy were associated with a worse prognosis. Low magnesium levels might be used as a new parameter indicating a worse prognosis. A high CCI and FGSI might be associated with a worse prognosis in patients with FG. A FGSI threshold of 9 was a predictor of mortality during the
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Cited by (68)
The Role of the Platelet Mass Index (PMI) as a New Prognostic Factor in Fournier's Gangrene
2018, African Journal of UrologyCitation Excerpt :In many studies, an increased ALP level has been identified as an indicator of poor prognosis; however, we found no difference between survivors and non-survivors. Magnesium (Mg) is an important intracellular cation, and its loss in the urine, impaired intestinal absorption, or intercellular shifts are mechanisms that cause low Mg levels [5]. Mg is an important regulator of cardiac contractility and also plays a role in wound healing [13].
Surviving Fournier's gangrene: Multivariable analysis and a novel scoring system to predict length of stay
2018, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Many patients still face the risk of mortality, confirmed by our rate of 5%, though these risks are relatively improved compared to several decades ago.3,14 Several studies have attempted to compare scoring systems in order to validate them, and many have proposed novel scoring systems to predict mortality and disease severity.7,8,10,16–21 Still, no scoring system has been developed to predict length of stay, and as the disease paradigm shifts towards increased survival, practitioners must consider reconstruction and quality of life outcomes.
Can HALP score, a new prognostic tool, take the place of traditional scoring systems in Fournier’s gangrene?
2023, International Urology and Nephrology