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Fournier's gangrene: A 10‐year review and validation of mortality predictors in a Hong Kong major regional centre
Author(s) -
Chan Brian YinOn,
Wong Ben WuiBun,
Lo Kelly KaYee,
Yim Carmen,
Tse Cyrus TakYin
Publication year - 2018
Publication title -
surgical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.109
H-Index - 10
eISSN - 1744-1633
pISSN - 1744-1625
DOI - 10.1111/1744-1633.12301
Subject(s) - medicine , gangrene , receiver operating characteristic , univariate analysis , surgery , emergency medicine , multivariate analysis
Aim Fournier's gangrene (FG) is a surgical emergency necessitating urgent debridement and aggressive antimicrobials. Early recognition of high‐risk patients enables timely critical care, but controversies existed in common scoring systems. No local data are available on their applicability and valid prognosticating factors; therefore, the aim of the present study was to improve triage and mortality. Patients and Methods Fifty patients with FG from 2006 to 2015 were retrospectively reviewed. Baseline demographics, physiological and laboratory values, management options, and parameters in established scoring systems were compared between survivors and nonsurvivors via univariate analyses. Receiver operating characteristic curves for the three commonest indexes were plotted to evaluate their diagnostic performance. Results Mortality was 20 per cent, compatible with international literature. Nonsurvivors had greater median age (63 vs 53 years, P = 0.05), smoking habit (70 vs 30 per cent, P = 0.03), diabetes (80 vs 38 per cent, P = 0.03), immunosuppression (100 vs 68 per cent, P = 0.046), orchidectomy (30 vs 3 per cent, P = 0.022) and serum creatinine (1.2 vs 0.91 mg/dL, P = 0.042) and lower haematocrit (31 vs 36 per cent, P = 0.006). No survival benefit was observed in the construction of defunctioning stoma and suprapubic catheterization. For scoring systems, no difference in translated score levels was seen. The area under the curve of the FG severity index was 0.798, whereas that for the simplified and Uludag versions were 0.588 and 0.833, respectively; all were statistically not significant. Conclusion Smokers and elderly, diabetic, or immunocompromised patients, those with a higher creatinine or lower haematocrit level and those requiring orchidectomy had a poorer prognosis and could benefit from intensive care. Current scoring systems either perform poorly or have troublesome frontline application. The present study is the first local study of such intent.