Ankara Numune Training and Research Hospital, Department of General Surgery, Ankara-Turkey.
Department of General Surgery, Bingöl State Hospital, General Surgery, Bingöl-Turkey.
Ulus Travma Acil Cerrahi Derg. 2022 Apr;28(4):490-497. doi: 10.14744/tjtes.2020.68137.
Many predictive factors and scoring systems associated with Fournier's gangrene have been proposed, including comorbidities, vital signs, biochemical and hematological parameters, and demographic characteristics of the patient. The aim of this study was to determine the strengths of the scoring systems that have been formed by revealing these factors from a wider perspective and in a larger patient population.
The patient population included 144 patients, 21 of whom died. Age, biochemical and hematological parameters, Uludag Fournier's Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI), and Age-Adjusted Charlson Comorbidity Index (ACCI) scores were analyzed using the Mann Whitney U-test due to their non-parametric distribution. Categorical data such as comorbidities, gender, need for positive inotropes, diversion ostomy status, and UFGSI grading status was analyzed with the Chi-square test, and independent risk factors were determined from the significant data emerging from univariate and multivariate logistic regression analysis. Their strengths were compared using the logistic regression model (Fournier's Gangrene Mortality Prediction Model: FGMPM) created through ROC analysis of the FGSI, UFGSI, and ACCI scores.
The results of the statistical analyses showed that albumin (p<0.001) and need for positive inotropic support (p<0.001) were independent risk factors for mortality and ROC analysis revealed that the created FGMPM regression model (AUC: 0.995) was a stronger model than the FGSI (AUC: 0.874), UFGSI (0.893), and ACCI (0.788) scoring systems.
The results of this study revealed that albumin and the need for positive inotropic support are independent risk factors for mortality. It is thought that the determination of these two parameters can be used to predict mortality more practically than the parameters used in the UFGSI and FGSI.
已经提出了许多与 Fournier 坏疽相关的预测因素和评分系统，包括合并症、生命体征、生化和血液学参数以及患者的人口统计学特征。本研究的目的是通过从更广泛的角度和更大的患者群体中揭示这些因素，确定已经形成的评分系统的优势。
患者人群包括 144 名患者，其中 21 名死亡。由于其非参数分布，使用 Mann-Whitney U 检验分析年龄、生化和血液学参数、乌尔达格 Fournier 坏疽严重指数 (UFGSI)、Fournier 坏疽严重指数 (FGSI) 和年龄调整 Charlson 合并症指数 (ACCI) 评分。使用卡方检验分析合并症、性别、是否需要正性肌力支持、转流造口状态和 UFGSI 分级状态等分类数据，并从单变量和多变量逻辑回归分析中出现的显著数据中确定独立危险因素。通过 ROC 分析 FGSI、UFGSI 和 ACCI 评分创建的逻辑回归模型（Fournier 坏疽死亡率预测模型：FGMPM）比较它们的优势。
统计分析结果表明，白蛋白 (p<0.001) 和需要正性肌力支持 (p<0.001) 是死亡的独立危险因素，ROC 分析显示创建的 FGMPM 回归模型 (AUC：0.995) 比 FGSI (AUC：0.874)、UFGSI (0.893) 和 ACCI (0.788) 评分系统更强。
本研究结果表明，白蛋白和需要正性肌力支持是死亡的独立危险因素。认为这两个参数的确定可以比 UFGSI 和 FGSI 中使用的参数更实际地预测死亡率。
