Case series of Fournier's gangrene: Affected body surface area - The underestimated prognostic factor

Abstract

ObjectivesIdentifying the factors affecting the outcome of patients with Fournier's Gangrene and assaying the accuracy of the Fournier Gangrene Severity Index (FGIS), the Uludag score (UdS), affected Body Surface Area (BSA) and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) model as prognostic tools.Materials and methodsRetrospective study involving all patients with Fournier's gangrene treated in our Hospital between January 2008 and December 2015. The epidemiological, clinical, biochemical and management data of these patients was obtained and analyzed.ResultsThe series includes 19 patients, 14 male and 5 female, with a median age of 70 (62; 78,5) years. The mortality rate was 21%. From the data analyzed, only the affected BSA (BSA>3.25%) was associated with mortality (p = 0.016). None of the established scores (FGSI; UdS; LRINEC) proved to be a useful tool for predicting mortality. The combination of affected BSA and FSGI (FGSI≥9 or BSA>3.25%), (p = 0.004) and the combination of the affected BSA and the LRINEC model (LRICEC≥8 and BSA>3.25%), (p = 0.004) led to a major improvement in these scores.ConclusionsAffected BSA is a useful prognostic factor in Fournier's gangrene. The existing prognostic scores can be improved with the introduction of this factor.

The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa

“…A number of these have been assessed, including the FGSI, Uludag FGSI (FGSI with age and extent of disease scores added), Age-adjusted Charlson Comorbidity Index (ACCI) and Surgical Apgar (sAPGAR) Score. [19] The affected body surface area [21] and the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) [22] have also been assessed. These tools can be used at the bedside to score patients and assist with decisions to refer to a higher centre, admit to ICU or withhold treatment.…”

“…Debridement outside the perineum is an indicator of extensive disease, and our finding RESEARCH that it was a risk factor concurs with other studies showing that the percentage of body surface area affected is a predictor of mortality. [21] The only risk factor that remained significant on multivariate analysis was requirement for organ support. The multivariate analysis was limited by the small sample size, particularly in the group of patients who died.…”

Escherichia coli producer of extended-spectrum beta-lactamases as causative agent of Fournier gangrene of urogenital origin associated with higher mortality

“…Subjecting the patients to vacuum-assisted closure therapy has been found to significantly decrease mortality 9 . Another factor associated with higher mortality is the percentage of body surface area involved, especially when it is larger than 3.25% 10 .…”

Escherichia coli productora de betalactamasas de espectro extendido como agente causal de gangrena de Fournier de origen urogenital asociada a mayor mortalidad

“…Se ha encontrado que someter a los pacientes a terapia de vacío disminuye significativamente la mortalidad 9 . Otro factor asociado a mayor mortalidad es el porcentaje de superficie corporal afectada, principalmente cuando esta es mayor del 3.25% 10 .…”