Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis

Abstract

Background: To provide better management of Fournier's gangrene, mortality-associated comorbidities and common etiologies were identified. Methods: A systematic search was conducted using 12 databases, followed by meticulous screening to select relevant articles. Meta-analysis and meta-regression (for possible cofounders) were both done for all possible outcomes. Results: Out of 1186 reports screened, 38 studies were finally included in the systematic review and metaanalysis. A higher risk of mortality was detected in patients with diabetes, heart disease, renal failure, and kidney disease, with risk ratios (RR) and 95% confidence intervals (95% CI) of 0.72 (0.59-0.89), 0.39 (0.24-0.62), 0.41 (0.27-0.63), and 0.34 (95% CI 0.16-0.73), respectively. However, there was no association between mortality rates and comorbid hypertension, lung disease, liver disease, or malignant disease (p > 0.05). The highest mortality rates were due to sepsis (76%) and multiple organ failure (66%), followed by respiratory (19.4%), renal (18%), cardiovascular (15.7%), and hepatic (5%) mortality. Conclusions: Modifications to the Fournier's Gangrene Severity Index (FGSI) are recommended, in order to include comorbidities as an important prognostic tool for FG mortality. Close monitoring of the patients, with special interest given to the main causes of mortality, is an essential element of the management process.

Effectiveness of Virtual Reality in the Rehabilitation of Motor Function of Patients With Subacute Stroke: A Meta-Analysis

“…Whenever publication bias was found, the trim-and-fill method of Duvall and Tweedie was applied to add studies that appeared to be missing ( 41 ) to enhance the symmetry. Furthermore, metaregression was used to explore the effect of “time passed since the last stroke” on the VR effectiveness ( 42 ). In the case of statistically significant results, a leave-one-out sensitivity analysis was performed by iteratively removing one study at a time to confirm that our findings were not driven by any single study ( 43 ).…”

<p>Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives</p>

“…16 Risk of mortality is significantly heightened in patients with diabetes, heart disease, and renal failure. 3 Additional risk factors include recent trauma or surgery and use of injection drugs such as cocaine or heroin, particularly if patients inject directly into inguinal veins, penile veins, or cavernosa. 17,18 Use of sodium-glucose cotransporter 2 inhibitors (SGLT2i)antihyperglycemics that augment urinary glucose excretion -have been related with FG in multiple case reports, submit your manuscript | www.dovepress.com…”

“…15,[33][34][35] Approximately one-quarter of FG cases are idiopathic with no known source. 3 However, the pathological processes leading to perineal and genital gangrene and sepsis can usually be tracked back to a gastrointestinal, genitourinary, or cutaneous primary lesion.…”

“…CT has high sensitivity (88.5%) and specificity (93.3) for NSTI diagnosis. 3,7,63 Common findings include fluid collections, abscesses, asymmetric fascial thickening, fat stranding, and subcutaneous emphysema (Figure 3). [82][83][84] Although excellent at characterizing soft tissue, magnetic resonance imaging is not recommended as the initial radiologic imaging modality due to high cost and extended time of examination.…”

“…The underlying etiology was unknown at the time, and it was thought to be an idiopathic disease of young men. 3 Despite Fournier's name given to the eponym, earlier physicians more accurately described the infection as occurring following an initial traumatic insult, particularly in susceptible populations. A cause is now found in the majority of cases, and it can present at any age and any sex.…”