Evaluation of scoring systems in predicting mortality in Fournier gangrene

Abstract

Aim: We aimed to evaluate the scoring systems in predicting severity and mortality in patients with Fournier gangrene.

Material and Methods: Demographic, clinical and laboratory data of 76 patients included in the study were retrospectively analyzed. Demographic characteristics, clinical and laboratory parameters including FGSI, UFGSI and NFS scores were calculated for each patient. ROC analysis of the scores was performed. P <0.05 was considered statistically significant.

Results: Of the 76 patients included in the study, 65 (85.5%) were discharged and 11 (14.5%) had mortality. All patients were divided into two groups: Group-1: Discharged patients and Group-2: Mortality. In ROC (receiver operating characteristic) analysis, AUC (Area Under The Curve) for FGSI, UFGSI and NFS scores was 0.890 (95% CI: 0.785-0.994, p = 0.000), 0.895 (95% CI: 0.810-, respectively). 0.981 (p = 0.000) and 0.867 (95% CI: 0.733-1, p = 0.000).

Conclusion: An ideal scoring system; to better understand this disease, to identify errors in unexpected situations and mortality should aim to be able to contribute to survival. We believe that NFS is a scoring system with simple, easy-to-evaluate parameters and may be very useful in assessing mortality in clinical practice.

Keywords

• Fournier gangrene,mortality,scoring

Fournier gangreninde mortaliteyi öngörmede skorlama sistemlerinin değerlendirilmesi

Abstract

Amaç: Fournier gangreni hastalarında şiddet ve mortaliteyi öngörmede skorlama sistemlerini değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Çalışmaya dahil edilen 76 hastanın demografik, klinik ve laboratuvar verileri elektronik ortamda retrospektif olarak incelendi. Çalışmada her hasta için demografik özellikleri, klinik ve laboratuvar parametrelerini içeren FGSI, UFGSI ve NFS skorları hesaplandı. Skorların ROC analizi yapıldı. Analizimiz sonucunda p<0,05 olanlar istatistiksel olarak anlamlı kabul edildi.

Bulgular: Çalışmaya dahil edilen 76 hastanın 65(%85,5)’i taburcu edilirken, 11(%14,5)’inde mortalite gelişti. Tüm hastalar, Grup-1: Taburcu edilen hastalar ve Grup-2: Mortalite gelişenler olarak iki gruba ayrıldı. ROC((receiver operating characteristic) analizinde; FGSI, UFGSI ve NFS skorları için AUC (Area Under The Curve=Eğrinin Altında Kalan Alan) sırasıyla 0,890 (%95 CI: 0.785-0.994, p=0.000), 0,895 (%95 CI: 0.810-0.981, p=0.000) ve 0,867 (%95 CI: 0.733-1, p=0.000) olarak bulundu.

Sonuç: İdeal bir skorlama sistemi; bu hastalığı daha iyi anlamak, beklenmedik mortalite durumlarında hataları tanımlayabilmek ve sağkalıma katkıda bulunabilmeyi amaçlamalıdır. NFS’nin basit, kolay değerlendirilen parametreler içeren bir skorlama sistemi olduğunu ve klinik pratikte mortaliteyi değerlendirmede oldukça faydalı olabileceğini düşünüyoruz.

Keywords

• Fournier gangreni,mortalite,skorlama

References

1. 1. Corman J, Moody J, Aronson W. Fournier's gangrene in a modern surgical setting: improved survival with aggressive management. BJU international 1999; 84: 85-88.
2. 2. Paty R, Smith A. Gangrene and Fournier's gangrene. The Urologic clinics of North America 1992; 19: 149- 62.
3. 3. Luther Ward M, Eisenson D, Fils J-L. Fournier's gangrene of the penis in a 12-year-old patient secondary to phimosis. Rhode Island Medical Journal 2016; 99: 45.
4. 4. Benjelloun EB, Souiki T, Yakla N et al. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality. World Journal of Emergency Surgery 2013; 8: 13.
5. 5. Morua AG, Lopez J, Garcia J, Montelongo RM, Guerra L. Fournier’s gangrene: our experience in 5 years, bibliographic review and assessment of the Fournier’s gangrene severity index. Arch Esp Urol 2009; 62: 532-40.
6. 6. Erdoğan A, Aydoğan İ, Şenol K, Üçkan E, Ersöz Ş, Tez M. Simple scoring system for prediction of mortality in Fournier’s gangrene. European Journal of Trauma and Emergency Surgery 2016; 42: 513-18.
7. 7. Eke N. Fournier's gangrene: A review of 1726 cases. British Journal of Surgery. 2000; 87: 718-28.
8. 8.Küçükdurmaz F. Fournier gangreninde mortaliteyi etkileyen faktörlerin değerlendirilmesi: 38 hastalık deneyimimiz. Yeni Üroloji Dergisi 2016; 12: 29-34.

9. 9. Tarchouli M, Bounaim A, Essarghini M et al. Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases. Canadian Urological Association Journal 2015; 9: 800.
10. 10. Sorensen MD, Krieger JN, Rivara FP, Klein MB, Wessells H. Fournier's gangrene: management and mortality predictors in a population based study. The Journal of urology 2009; 182: 2742-47.
11. 11. Yilmazlar T, Ozturk E, Ozguc H, Ercan I, Vuruskan H, Oktay B. Fournier’s gangrene: an analysis of 80 patients and a novel scoring system. Techniques in coloproctology 2010; 14: 217-23.
12. 12. Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. The Journal of urology 1995; 154: 89-92.
13. 13. Dahm P, Roland FH, Vaslef SN et al. Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia. Urology 2000; 56: 31-35.
14. 14. Yılmazlar T, Işık Ö, Öztürk E, Özer A, Gülcü B, Ercan İ. Fournier’s gangrene: review of 120 patients and predictors of mortality. Ulus Travma Acil Cerrahi Derg. 2014; 20: 333-37.
15. 15. Erol B, Tuncel A, Hanci V et al. Fournier's gangrene: overview of prognostic factors and definition of new prognostic parameter. Urology 2010; 75: 1193-98.
16. 16. Janane A, Hajji F, Ismail T et al. Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier's gangrene: Usefulness of a severity index score in predicting disease gravity and patient survival. Actas Urológicas Españolas (English Edition) 2011; 35: 332-38.