The clinical features of Fournier’s gangrene and the predictivity of the Fournier’s Gangrene Severity Index on the outcomes

Abstract

Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Several factors have been reported to contribute to the clinical outcomes. The primary aims of this study were to examine the clinical features of patients with FG and evaluate the predictivity of the Fournier's Gangrene Severity Index (FGSI) score on the outcomes. We carried out a collective retrospective chart review of patients diagnosed and treated for FG in three reference centers between January 1995 and July 2007. Seventy-two patients with FG with were included to the study. Data were collected on medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement and antibiotic therapy. Perianal and perirectal abscess, scrotal abscess and urethral stenosis were the leading etiological factors. Diabetes mellitus was the predominant risk factor. Etiological factors and risk factors did not significantly contribute to survival or mortality, and duration of the symptoms was significantly longer in the non-survivor's group (P < 0.05). The FGSI scores were higher in the non-survivor's group. Regression analysis showed a FGSIS score of 10.5 as the cut-off to the outcome. Based on these results, we conclude that a patient's metabolic status and the extent of disease at presentation are the most important factors determining the prognosis of FG. The FGSI score may be considered as an objective and simple tool to predict the outcome in the patient with FG and should be used in further studies of FG patient series for comparison purposes.

Fournier's Gangrene: Review of 120 Patients and Predictors of Mortality

“…[1,[16][17][18] A study including 379 patients identified from a nationwide database has suggested that early surgical treatment within two days after admission reduces mortality of FG. [17] Also, the interval time between the onset of symptoms and initial debridement has been reported to be a major predictor of mortality.…”

“…[1,3,6,7] Nevertheless, there are also some studies where DM has been reported as one of the most frequent comorbidities in patients with FG although not influencing outcomes. [8][9][10][11]16,19] Although it was the most common co-morbidity among all patients, DM was not determined as a risk factor for mortality (p=0.429).…”

Teoria De Betty Neuman Na Abordagem De Pessoas Com Gangrena De Fournier

“…Dessa forma, o enfermeiro deve ser capaz de prever situações de origem externa que são potenciais agravantes da condição de saúde do indivíduo. Pensar no cuidado de enfermagem desvinculado ao modelo biomédico ainda é um desafio (13) , sobretudo nas doenças de progressão rápida e que oferecem risco iminente de morte, a exemplo da Gangrena de Fournier (6) . Sendo assim, o uso de referenciais teórico-filosóficos subsidia o processo de tomada de decisão clínica e diminui os riscos de se reproduzir um cuidado de enfermagem moldado no caráter biomédico, que é mais passível de iatrogenias (12,15) .…”

“…Por ser de etiologia polimicrobiana, envolve bactérias aeróbias e anaeróbias e apresenta risco elevado para septicemia (2)(3)(4) . A definição precoce do quadro clínico de GF aumenta a chance de melhores prognósticos e menores índices de mortalidade (5)(6) . O enfermeiro, a partir do acompanhamento dos sinais e sintomas e de uma coleta de dados episódica, é capaz de atuar em conjunto com a equipe médica no diagnóstico rápido da GF, favorecendo tratamento e recuperação do indivíduo (4)(5)7) .…”

“…A saúde se equivale à estabilidade ideal do sistema, no qual o equilíbrio é traduzido como o melhor estado de saúde, cabendo ao enfermeiro a capacidade de vincular paciente, ambiente e saúde, a fim de manter a estabilidade desses componentes (15) . Entendendo a GF como uma enfermidade com potencial comprometimento sistêmico e risco de morte (6) , identificou-se a necessidade de desenvolver impressos capazes de sistematizar o cuidado de enfermagem junto à pessoa com GF, a fim de otimizar as ações de enfermagem no controle e recuperação do indivíduo, bem como reduzir iatrogenias (12) . A construção dos impressos se deu também, a partir da necessidade de se pensar um cuidado de enfermagem especializado que envolvesse as demandas psicológicas, sociais e espirituais do indivíduo com GF.…”