The importance of the scoring system in Fournier’s gangrene

BACKGROUND: The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier’s gangrene (FG) and develop methods to increase the survival rate.
METHODS: We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Taþçýoðlu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species.
RESULTS: The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively.
CONCLUSION: Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

Fournier gangreninde skorlama sisteminin önemi

AMAÇ: Fournier gangreninde (FG) mortaliteyi etkileyen faktörleri araþtýrarak, saðkalýmý arttýrabilecek yöntemleri geliþtirmek amaçlanmýþtýr. GEREÇ VE YÖNTEM: Ýstanbul Prof. Dr. Cemil Taþçýoðlu Þehir Hastanesi Cerrahi Kliniði’nde 01.02.2012–30.06.2021 tarihlerinde FG tanýsýyla yatan 73 olgu geriye dönük incelendi. Saðkalanlar (Grup 1: 56), ölenler (Grup 2: 17) olarak ayrýldý. Gruplar cins, yaþ, enfeksiyonun geniþliði, Uludað Fournier Gangreni Þiddet Ýndeksi (UFGSI), Fournier Gangreni Þiddet Ýndeksi (FGSI), enfeksiyonun kaynaðý, yandaþ hastalýklar, stoma varlýðý, Vacuum Assisted Closure süresi, yattýðý gün sayýsý, yoðun bakým süresi (YBS), bakteri türleri açýsýndan karþýlaþtýrýldý. Sonuçlar, SPSS 21.0 programý kullanýlarak deðerlendirildi.
BULGULAR: Mortalite %23’dü, 31 kadýn, 42 erkek içeriyordu. Gruplar arasýnda cinsiyette anlamlý fark bulundu (p=0.001). Toplamda ortalama yaþ 57.29±13.36, Grup 1’dekilerin ortalama yaþý (53.66±11.185) Grup 2’dekilerin ortalamasýndan (69.24±13.264) anlamlý küçüktü (p=0.000). Enfeksiyonun geniþliði Grup 1’de anlamlý düþüktü (p=0.011). UFGSI ve FGSI skorlarý Grup 1’de Grup 2’den anlamlý düþüktü (sýrasýyla p=0.00, p=0.009). Hematokrit, bikarbonat deðerleri Grup 2’de anlamlý düþüktü (p=0.000, p=0.015). UFGSI ve FGSI, mortalitenin öngörülmesinde sýrasýyla %100 ve %82 duyarlýlýk ve sýrasýyla %68 ve %58 özgüllüðe sahipti. UFGSI ve FGSI eþik deðerleri 8 ve 6 bulundu. Grup 1’dekilerin 29’unda, Grup 2’dekilerin tamamýnda yandaþ hastalýklar vardý, anlamlý fark bulundu (p=0.000). YBS Grup 2’de anlamlý uzundu (p=0.000).
TARTIÞMA: UFGSI 8’den küçük hastalarda saðkalým yüksek, nadiren yoðun bakým gerektirir. UFGSI 8’den büyük hastalarda mortalite yüksektir. Bu hastalar genel cerrahi, plastik cerrahi, yoðun bakým uzmanýndan oluþan deneyimli bir takým tarafýndan yoðun bakým ünitesinde tedavi edilmelidir.