Eray Ismail Cem, Dalci Kubilay, Gumus Serdar, Yalav Orcun, Saritas Ahmet Gokhan, Boz Asli, Rencuzogullari Ahmet
Division of Colorectal Surgery, Department of General Surgery, Çukurova University Faculty of Medicine, Adana, Turkey.
Department of Surgical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey.
Ann Coloproctol. 2023 Jun;39(3):223-230. doi: 10.3393/ac.2021.00843.0120. Epub 2022 Feb 3.
This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG).
Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses.
The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death.
The CRP ratio is a simple method to use to predict mortality in FG.
本研究旨在确定C反应蛋白（CRP）比值对福尼尔坏疽（FG）患者生存情况的影响。
回顾性分析2011年1月至2018年9月期间的52例FG患者。分析临床表现、福尼尔坏疽严重程度指数（FGSI）、CRP比值、治疗方法及预后等数据。CRP比值计算为手术干预48小时后测量的术前CRP/术后CRP值。通过受试者工作特征（ROC）分析确定FGSI和CRP可能的替代截断点。通过单因素和多因素逻辑回归分析评估与预后相关的危险因素。
存活组的平均CRP比值为6.7±6.6，非存活组为1.2±0.8（P=0.001）。非存活组的FGSI显著高于存活组（8.5±2.5对3.5±2.2，P=0.001）。FGSI与CRP比值呈负相关（r=-0.51）。ROC分析确定CRP预测死亡的截断值为1.78（敏感性86%；特异性82%；ROC曲线下面积0.90）。CRP比值≤1.78的患者死亡发生率比CRP比值>1.78的患者增加26.7倍（95%置信区间[CI]，4.8-146.5；P=0.001）。在多因素逻辑回归模型中，CRP比值（比值比[OR]，10.3；95%CI，1.5-72.2；P=0.019）和FGSI（OR，17.8；95%CI，2.6-121.1；P=0.003）是死亡的独立危险因素。
CRP比值是预测FG患者死亡率的一种简单方法。
