Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Are More Effective than the Fournier's Gangrene Severity Index for Predicting Poor Prognosis in Fournier's Gangrene

Yim, Sang Un; Kim, Sun Woo; Ahn, Ji Hoon; Cho, Yang Hyun; Chung, Ho Seok; Hwang, Eu Chang; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

doi:10.1089/sur.2015.126

Cited by 21 publications

(30 citation statements)

References 27 publications

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“…Escherichia coli was the most frequently identified pathogen (14.4%), followed by retrospective study and found that high NLR and high PLR were independent prognostic factors for poor prognosis from Fournier's gangrene. 24 Wong et al developed the laboratory risk indicator for NF (LRINEC) score in 2004, which is widely accepted for risk stratification in NF. 25 Using white blood cell count, hemoglobin, sodium, glucose, serum creatinine and serum C-reactive protein they developed a scoring system for the likelihood of NF on admission in the emergency department.…”

Section: Resultsmentioning

confidence: 99%

Mortality from necrotizing fasciitis: a cross-sectional study

2020

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Background: Necrotizing fasciitis refers to the rapidly progressive inflammation of the fascia, with secondary necrosis of subcutaneous tissues. Due to the high mortality, it is considered a surgical emergency, needing timely diagnosis and appropriate treatment with early debridement. The aim of the study was to analyse the clinical profile of patients with necrotizing fasciitis so as to determine the mortality and the risk factors associated with mortality and other poor outcomes.Methods: This retrospective cross-sectional study was conducted in a tertiary hospital in Kerala, from January 2016 through January 2018. 175 cases were identified through the ICD codes for necrotizing fasciitis and Fournier’s gangrene in the discharge and death registers; and data were obtained about these patients. The data were analyzed to assess the study objectives.Results: In this study mortality was found to be 22.7%. Diabetes mellitus was found to be the most common co-morbid disease and had a significant association with increased risk of amputation. Mixed growth (type I NF) was the most common microbiological isolate and Pseudomonas was the most common gram-negative isolate. 4 cases of MRSA were recorded. Klebsiella infection was found to have increased risk of undergoing limb amputation. 7.4% of the patients required amputation during hospital stay for infection control.Conclusions: Necrotizing fasciitis has a high mortality. Diabetes mellitus was found to be the most common co-morbid disease. Increased blood glucose and low serum albumin had a significant association with an increased risk of amputation. Proper control of these factors is essential to reduce mortality from this condition.

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Section: Resultsmentioning

confidence: 99%

Mortality from necrotizing fasciitis: a cross-sectional study

2020

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“…73 The neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) are newer validated clinical scoring tools with wide use for predicting disease severity in many inflammatory and infectious conditions, recently utilized for FG as well. 74,75 Yim et al (2016) determined that admission labs demonstrating PLR> 140 and NLR >8 were associated with 11.6 and 4.66fold increased odds of mortality, respectively. 75 Higher neutrophil-lymphocyte and platelet-lymphocyte ratios are indicative of worse prognosis.…”

Section: Laboratory Investigations and Clinical Scoring Systemsmentioning

confidence: 99%

“…74,75 Yim et al (2016) determined that admission labs demonstrating PLR> 140 and NLR >8 were associated with 11.6 and 4.66fold increased odds of mortality, respectively. 75 Higher neutrophil-lymphocyte and platelet-lymphocyte ratios are indicative of worse prognosis. Retrospective comparison of the FGSI against NLR and PLR in patients with FG found higher NLR and PLR values correlated with higher mortality, including in…”

Section: Laboratory Investigations and Clinical Scoring Systemsmentioning

confidence: 99%

“…patients for which the FGSI did not show any statistically significant effect on mortality. 34,75,76 Additional benefits of the NLR and PLR tools are their simplicity of use and low cost, particularly in low resource settings. FGSI and NLR have also been used by urological services as reliable parameters for predicting skin reconstruction method between primary skin closure versus graft and flap.…”

Section: Dovepressmentioning

confidence: 99%

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

Auerbach¹,

Bornstein²,

Ramzy³

et al. 2020

OAEM

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Fournier gangrene (FG) is a rare and life-threatening urosurgical emergency characterized most often by a polymicrobial infection of the perineal, genital, or perianal region. FG has an increased incidence in male patients, patients with alcoholism, and patients with immunocompromise including human immunodeficiency virus (HIV) and uncontrolled diabetes. FG often begins as a simple abscess or cellulitis with progression to necrotizing soft tissue infection (NSTI). Delays in diagnosis and treatment confer high mortality. Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle. The most significant modifiable risk factor associated with NSTI mortality is delay to surgical intervention. Coordination of both inpatient medical and surgical teams to implement appropriate therapy is vital to successful outcomes. The emergency medicine clinician must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management. The objective of this review is to provide updated and relevant information regarding recognition, diagnosis, and management of FG for the emergency medicine provider.

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“…It was used to clean and disinfect wounds in the 20th century. 4 Dakin's solution is effective against a wide range of aerobic and anaerobic organisms and fungi, including organisms that are highly resistant to systemic antibiotics. 5 In this study, we aimed to show potentially efficient of Dakin's solution on wound healing, reoperation rate and mortality on FG.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of Dakin’s solution in wound care after debridement in Fournier’s gangrene

Karslı¹,

Gökalp²

2020

Int Surg J

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Background: Fournier's gangrene (FG) is a specific form of necrotizing fasciitis seen in the external genital organs and perianal region. The basic management of Fournier's gangrene is based on critical surgical debridement. Dakin's solution (sodium hypochlorite) was originally developed to treat war wounds. In this study, we aimed to show potentially efficient of Dakin’s solution on wound healing and reoperation rate.Methods: Thirty-three patients who were debrided due to Fournier Gangrene during 2012-2020 were included in the study. After debridement, wound care was done twice a day by dressing with a sponge moistened with Dakin's solution. Patients' age, concomitant disease, involvement site, re-debridement requirement, complications, and discharge times were recorded.Results: The mean age of 33 male patients who participated in the study was (51-74) 63.93±15.36. Although all patients had scrotal involvement, nine patients had perineal (27.2%), 12 patients had inguinal (36.3%), four patients had a penis and pubic spread (12.1%). The mortality rate was 6%. The average length of hospital stay was 13.1±4.2 days, and the average number of debridements was 1.Conclusions: Fournier gangrene is an important disease characterized by necrotizing infection of the genital, perineal, and perianal region and progresses with high mortality. Our mortality rate was lower than literature and we have linked our mortality rate to using Dakin's solution for wound care. Dressing with Dakin's solution is an effective and reliable method for wound care in FG patients.

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Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Are More Effective than the Fournier's Gangrene Severity Index for Predicting Poor Prognosis in Fournier's Gangrene

Abstract: The Fournier's Gangrene Severity Index scoring system was not associated with determining poor prognosis, however, high NLR and high PLR were associated with predictors of mortality in patients with Fournier's gangrene.

Cited by 21 publications

References 27 publications

Mortality from necrotizing fasciitis: a cross-sectional study

Mortality from necrotizing fasciitis: a cross-sectional study

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

The effectiveness of Dakin’s solution in wound care after debridement in Fournier’s gangrene

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