Predicting Mortality in Fournier Gangrene and Validating the Fournier Gangrene Severity Index: Our Experience with 50 Patients in a Tertiary Care Center in India
| Autor: | Amandeep Arora, Anurag Narwade, Shrinivas Surpam, Sameer Rege, Kalyansing Gothwal |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Alcoholic liver disease Critical Care Urology 030232 urology & nephrology India Severity of Illness Index Diabetes Complications Tertiary Care Centers Young Adult 03 medical and health sciences Patient Admission 0302 clinical medicine Internal medicine Diabetes mellitus Intensive care Diabetes Mellitus Humans Medicine Postoperative Period Prospective Studies Liver Diseases Alcoholic Aged Retrospective Studies Aged 80 and over Gangrene Principal Component Analysis Receiver operating characteristic business.industry Mortality rate Malnutrition Area under the curve Fournier gangrene Middle Aged Prognosis medicine.disease Hospitalization Treatment Outcome ROC Curve 030220 oncology & carcinogenesis Female business Fournier Gangrene |
| Zdroj: | Urologia Internationalis. 102:311-318 |
| ISSN: | 1423-0399 0042-1138 |
| DOI: | 10.1159/000495144 |
| Popis: | Objective: To identify factors that dictate morbidity and mortality in patients with Fournier’s Gangrene and validate the Fournier gangrene severity index (FGSI). Materials and Methods: We prospectively studied 50 patients with FG from January 2016 to December 2016 pertaining to their presenting signs, intraoperative findings, and postoperative wound management and outcome. We also checked the power of the FGSI to predict the outcome of the patients in terms of mortality. Receiver operating characteristic curve was used to determine the optimum cutoff of FGSI score to predict mortality. Principle component analysis was performed to check for the possibility of reduction in the number of factors included in the FGSI. Results: The mean age at presentation was 53 ± 16 years with a mortality rate of 24%. Factors associated with mortality were increasing age (p = 0.0001), presence of diabetes (p = 0.002), bed-ridden status (p = 0.001), alcoholic liver disease (p = 0.005), altered international normalized ratio (p > 0.005), late presentation (p = 0.001), and a FGSI score of > 9 at admission (p = 0.004). The mean FGSI score among survivors was 4.39 ± 3.80 compared to 14.22 ± 3.93 among those who died. The area under the curve FGSI score to predict mortality at a cutoff of 9 was 0.961 (95% CI 0.910–1.000). Conclusion: Increasing age, diabetes, alcoholic liver disease, bed-ridden status, delayed hospital presentation, and an altered international normalized ratio at presentation are associated with higher mortality in FG. The FGSI at admission should be used to identify patients with serious prognosis requiring intensive care. |
| Databáze: | OpenAIRE |
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