Hauser Nicholas, Huang Chenlin, Vaidya Girija, Chrusciel Timothy, Narayana Kumarasan Krithika, Culhane John, Siddiqui Sameer
Urology, Saint Louis University School of Medicine, Saint Louis, USA.
Urology, Baylor College of Medicine, Houston, USA.
Cureus. 2024 Dec 7;16(12):e75281. doi: 10.7759/cureus.75281. eCollection 2024 Dec.
Introduction Fournier's gangrene (FG) is a rapidly progressing necrotizing fasciitis. The Fournier's Gangrene Severity Index (FGSI), in conjunction with the Charlson Comorbidity Index (CCI), has been used as a mortality predictor during hospitalization. Patients with diabetes have also been shown to be at an increased risk for the development of FG. This study explores the potential of using FGSI, CCI, and patient diabetes status in predicting more extensive patient outcomes, including intensive care unit (ICU) admission and length of hospital stay. Methods From 2013 to 2023, inpatient admissions with the diagnosis of FG were selected from the EPIC Clarity database of the Sisters of St. Mary hospital system. Patient demographics, ICU admission, length of hospital stay, medical comorbidities, and calculated FGSI and CCI scores were extracted from selected admissions. Logistic regression and generalized linear regression models were performed for regression analysis. Results A total of 264 patients who met our inclusion criteria were admitted for FG from 2013 to 2023. The patient population was all male with a mean age of 54.7 years. Of the cohort, 127 patients (48.1%) required ICU care, and 44 patients (16.7%) died during admission. Of the 164 patients (62.1%) diagnosed with diabetes, 13 were taking sodium-glucose cotransporter 2 (SGLT-2) inhibitors prior to admission, and 121 were insulin-dependent. No relationship could be found between the use of SGLT-2 inhibitors or insulin and patient outcome. For every one-unit increase in FGSI score, the odds of mortality increased by 1.14 times, the odds of being admitted to the ICU increased by 1.3 times, and the length of hospital stay increased by 1.1 days (p<0.0001). For every one-unit increase in CCI score, the odds of mortality increase by 1.2 times (p=0.003), and the length of hospital stay increased by 0.9 days (p=0.04). Conclusions Insulin-dependent diabetes and the use of SGLT-2 inhibitors are not risk factors for more severe FG. FGSI and CCI scores may be used to predict patient outcomes beyond mortality, including ICU admission and length of hospital stay.
引言
福尼尔坏疽（FG）是一种进展迅速的坏死性筋膜炎。福尼尔坏疽严重程度指数（FGSI）与查尔森合并症指数（CCI）一起，已被用作住院期间的死亡率预测指标。糖尿病患者发生FG的风险也已被证明有所增加。本研究探讨了使用FGSI、CCI和患者糖尿病状态预测更广泛患者结局的潜力，包括重症监护病房（ICU）入住情况和住院时间。
方法
从圣玛丽医院系统的EPIC Clarity数据库中选取2013年至2023年诊断为FG的住院患者。从选定的入院病例中提取患者人口统计学信息、ICU入住情况、住院时间、合并症以及计算得出的FGSI和CCI评分。进行逻辑回归和广义线性回归模型以进行回归分析。
结果
2013年至2023年共有264例符合纳入标准的患者因FG入院。患者均为男性，平均年龄54.7岁。在该队列中，127例患者（占48.1%）需要ICU护理，44例患者（占16.7%）在住院期间死亡。在164例（占62.1%）诊断为糖尿病的患者中，13例在入院前使用钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂，121例依赖胰岛素。未发现使用SGLT-2抑制剂或胰岛素与患者结局之间存在关联。FGSI评分每增加一个单位，死亡几率增加1.14倍，入住ICU的几率增加1.3倍，住院时间增加1.1天（p<0.0001）。CCI评分每增加一个单位，死亡几率增加1.2倍（p=0.003），住院时间增加0.9天（p=0.04）。
结论
胰岛素依赖型糖尿病和使用SGLT-2抑制剂不是更严重FG的危险因素。FGSI和CCI评分可用于预测除死亡率之外的患者结局，包括ICU入住情况和住院时间。
