Comparison of Mortality in Fournier's Gangrene with the Two Scoring Systems

Abstract

Fournier's gangrene (FG) is necrotizing fasciitis of the perianal and genital regions, caused by interdependent polymicrobial infections. Identifying the symptoms early is critical as delay in diagnosis and treatment can be fatal. The clinical presentation of this disease is highly variable, ranging from early, localised skin hardening, redness, and swelling to more obvious dermal indications during the later stages including up to sepsis, which is a systemic finding. FG usually begins with perianal or perineal pain. 1 Scrotal swelling, deep local erythema, hyperemia, pruritus, fever, and nonspecific abdominal pain are other common symptoms. Minimal skin lesions in the early phase of FG may lead to the disease being overlooked because a definitive diagnosis is difficult. The rapid and aggressive nature, symptoms, and outcomes of this disease can sometimes manifest themselves in apparent findings such as deep tanning, cyanosis, foul-smelling flow, and even necrosis. [1][2][3] The repulsive faecaloid odour is another characteristic of the disease. Black dermal necrosis prevails with the development of gangrene. Reduction or even loss of pain with gangrene formation is typical. 4 The disease was described by Jean Alfred Fournier, dermatologist and venereologist in Paris, in 1883. [2][3][4] Present, FG affects every age group but its incidence increases after 50 years of age. 4 Interestingly, FG is closely related to low socioeconomic status and it is more prevalent in low-income societies. 2 The infection is most frequently of colorectal origin (30-50%) in terms of etiology, followed by the urological (20-40%) and dermal (20%). 3 It is frequently associated with accompanying systemic disorders, independent of the primary effect. For example, diabetes mellitus (DM) has been detected in 20-70% of FG cases. 1,3 Chronic alcoholism is the second most common cause (25-50%). 1,3 The underlying element shared by all of these associated risk factors is the impaired of immune resistance due to reduced cellular immunity. 2 The main bases of treatment are contained hemodynamic stabilisation, parenteral appropriate antibiotics,

Validation of FGSI Scores in Predicting Fournier Gangrene in Tertiary Hospital

“…The FGSI is a good prognostic tool for assessing patients with Fournier gangrene. 4 Mean FGSI in our study was 5.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) in the surviving patients (first group), and an average of 14 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) in the deceased patients (second group), which is significantly higher than the first group (p = 0.001). In our study, 11 points was agreed to be taken as the cut-off score rather than 9 as the other study does, but we have still taken the 9-points…”

“…Hypertension (9.4%), HIV (5.2%), the presence of fistula (6%), stricture (6%), and malignancy (2.3%) were also detected in patients' comorbid history. From the Fournier's Gangrene Severity Index (FGSI), in the first group we found the average score was 5.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and the average was 14 (10-19) in the second group, which is significantly higher than the first group (p = 0.001). In our study with FGSI cut-off score, we found that in the first group, 42 patients (70%) were alive and 1 died (4.3%) with cut-off score < 9, while 49 patients (81.6%) were alive and 4 died (17.3%) with cut off score < 11.…”

“…8 The positive A study denoted 8 died of 12 cases with a score > 9 of UFGSI. 9 In Hasan Sadikin Hospital, the study concerning of FGSI score and its cut-off point was not yet established. The objective of this study was to validate the factors related to increased mortality and/or morbidity using FGSI scoring in patients with Fournier gangrene treated in Hasan Sadikin General Hospital.…”

Neue Aspekte zur Fournierschen Gangrän – Ein Rapid Review

“…Bei den retrospektiven Untersuchungen handelt es sich um 11 Fallserien mit insgesamt 860 FG Patienten [24][25][26][27][28][29][30][32][33][34][35] sowie eine retrospektive Kohortenanalyse mit epidemiologi-that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure.…”

“…Dabei kommen die Autoren zu dem Ergebnis, dass die VAC zwar eine effektive Me-BMI = Body Mass Index; FG = Fourniersches Gangrän; FGSI = Fournier´s Gangrene Severity Index; HBO = hyperbare Oxygenierung; HR = Hazard Ratio; KI = Konfidenzintervall; OR = Odds Ratio; UFGSI = Uludag FGSI; VAC = vakuum-assistierter Wundverschluss thode, aber nicht effektiver als eine konventionelle Wundbehandlung ist[39]. hin Optimierungsbedarf gibt[24,29,30,[33][34][35].Radcliffe et al konnten sogar zeigen, dass sich die Mortalitätsrate in den letzten 25 Jahren nicht signifikant geändert hat und bei etwa 19,8 % liegt [33]. Dies stimmt mit den Ergebnissen von Kranz et al aus dem Jahre 2018 überein.…”