Outcomes of patients with Fournier’s Gangrene: 12-year experience from a tertiary care referral center

Özet

Objective: To highlight changing trends of the clinical spectrum, and compare the management optionsand predictors of Fournier’s gangrene (FG) outcomes in a tertiary care referral center.Material and methods: This study included patients with FG between August 2005 and July 2017. Patients were classified as “responders” and “nonresponders.” We compared the baseline characteristics,clinical spectrum, biochemical data, management modalities, outcomes, and FG severity index (FGSI)and age-adjusted Charlson Comorbidity Index (ACCI) between responders and nonresponders.Results: We studied 72 patients and further divided them to responders (60 patients) and non-responders(12 patients). All were males; the mean age was 56.27+19.27 years (range, 47–85 years). The most common complaints were perineal discomfort (n=62; 86.1%) and fever (n=48; 66.7%). FG originated from thepenoscrotal region in 64 patients (88.8%) and perineal region in 8 patients. Diabetes mellitus was the mostcommon comorbidity (36%). The mean duration of the presentation was 10.19 days (range, 7–30 days).Sixteen patients underwent split skin grafting. The mortality rate was 8.3%. Nonresponders had distinctfindings relative to responders: advanced age (71.5±7.17 vs. 53.23±19.85 years; p=0.00); high blood sugar(245.83±116.26 vs. 139.06±35.64 mg/dL; p<0.01); leukocytosis (27166.67±10295.75 vs. 10558.4±3130.64cumm; p<0.01); elevated serum creatinine (3.78±1.43 vs. 1.38±1.00; p<0.01); hyponatremia (127.33±11.84vs. 137.33±3.42 meq/l; p<0.01), elevated international normalized ratios (1.66±0.28 vs. 1.32±0.07;p<0.01); and high FGSI (9.83±1.11 vs. 6.46±1.68;p<0.01) and ACCI scores (6.33±0.49 vs. 5±0.82; p<0.01).On univariate and multivariate regression analysis, raised blood sugar and deranged international normalized ratios at presentation were significantly associated with decreased response to treatment (p<0.05).Conclusion: An advanced age, diabetes mellitus, renal impairment, leukocytosis, altered sensorium, shock atpresentation, deranged international normalized ratios, and high FGSI and ACCI scores can be used as predictors for poor response. FG risk scores adequately characterize the severity and prognosis of FG, but clinician’sjudgement is vital. The management comprises of a multidisciplinary approach, including parenteral antibiotics, urgent surgical debridement, and comorbidities optimization.