From the Department of Plastic, Reconstructive, and Aesthetic Surgery and the Department of Anesthesiology and Reanimation, Yuzuncu Yil University Faculty of Medicine.
Plast Reconstr Surg. 2018 Jul;142(1):68e-75e. doi: 10.1097/PRS.0000000000004516.
The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis.
Records of patients diagnosed with Fournier gangrene were analyzed retrospectively.
Seventy-four patients (49 men and 25 women) with a mean age of 57.60 ± 15.34 years (range, 20 to 95 years) were included. Sixty-eight participants were discharged and six died during follow-up. In the discharged group, during hospitalization, there was a trend downward in neutrophil-to-lymphocyte ratio and mean platelet volume values, whereas platelet count increased significantly. In the nonsurvivor group, the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement and at the end of hospitalization were significantly higher; platelet counts at admission, after the first débridement, and at the end of hospitalization were significantly lower compared with the survivor group (p < 0.05). In correlation analysis, mortality rate was negatively correlated with platelet count at admission and after first débridement and positively correlated with the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement. Regarding the receiver operating characteristic curve analyses, a platelet count of 188,500/µl at admission and 196,000/µl after the first débridement, a neutrophil-to-lymphocyte ratio of 13.71, and a mean platelet volume of 9.25 fl after the first débridement were defined as the cutoff levels having the best sensitivities and specificities.
This study suggests that platelet count at admission and platelet count, mean platelet volume, and neutrophil-to-lymphocyte ratio after first débridement and during discharge may be included among the prognostic scores of Fournier gangrene. The authors defined some threshold values that can be used during patient follow-up. Larger prospective studies are warranted to determine the exact role of those parameters in the prognosis of Fournier gangrene.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
作者研究了平均血小板体积、中性粒细胞与淋巴细胞比值和红细胞分布宽度值与住院患者中诊断为 Fournier 坏疽的血小板计数的变化，以确定它们与疾病预后的关系。
回顾性分析诊断为 Fournier 坏疽的患者记录。
纳入 74 例患者（男 49 例，女 25 例），平均年龄 57.60±15.34 岁（20~95 岁）。68 例患者出院，6 例患者在随访期间死亡。在出院组中，住院期间中性粒细胞与淋巴细胞比值和平均血小板体积值呈下降趋势，而血小板计数显著增加。在非存活组中，首次清创术后和住院期末的中性粒细胞与淋巴细胞比值和平均血小板体积显著升高；与存活组相比，入院时、首次清创术后和住院期末的血小板计数显著降低（p<0.05）。在相关分析中，死亡率与入院时和首次清创术后的血小板计数呈负相关，与首次清创术后的中性粒细胞与淋巴细胞比值和平均血小板体积呈正相关。关于受试者工作特征曲线分析，入院时血小板计数为 188,500/µl，首次清创术后为 196,000/µl，首次清创术后中性粒细胞与淋巴细胞比值为 13.71，平均血小板体积为 9.25fl 被定义为具有最佳敏感性和特异性的截止水平。
本研究表明，入院时血小板计数以及首次清创术后和出院时血小板计数、平均血小板体积和中性粒细胞与淋巴细胞比值可能被纳入 Fournier 坏疽的预后评分中。作者定义了一些可以在患者随访期间使用的阈值。需要更大规模的前瞻性研究来确定这些参数在 Fournier 坏疽预后中的确切作用。
临床问题/证据水平：风险，III 级。
