Fournier gangrenli hastalarda mortalite tahmininde FGSÝ ve UFGSÝ skorlama sistemlerinin prediktif deðeri: Çok merkezli çalýþma

AMAÇ: Fournier gangreni (FG) hastalýðýnýn mortalite tayininde Fournier gangreni skorlama indeksi (FGSÝ) ve Uludað FGSÝ’lerinin (UFGSÝ) prediktivitesini araþtýrmak amaçlandý.
GEREÇ VE YÖNTEM: Ýki eðitim ve araþtýrma hastanesi genel cerrahi kliniðinde Ocak 2012 ile Aralýk 2015 tarihleri arasýnda FG nedeniyle takip ve tedavi edilen olgular mortalite ile iliþkili faktörler yönünden deðerlendirildi. Mortalite iliþkili faktörler ve hastalýk prognozunun tayini için FGSÝ ve UFGSÝ skorlama sistemlerinin duyarlýlýklarýna bakýldý. Olgular yaþayan (Grup I) ve mortalite görülen (GrupII) olarak gruplandýrýldý.
BULGULAR: Toplam 29 olgu çalýþmaya dahil edildi. Yaþ ortalamasý 51.52±13.36 idi. Mortalite oranýmýz %20.6 (6 olgu) idi. Olgularýn 17’sinde (%58.6) yara kültüründe üreme saptandý. Üreme olan olgularýn 11’i (%47.8) Grup I, 6’sý (%100) Grup II’de idi. Bakteri üreme varlýðý mortalite açýsýndan istatistiksel olarak anlamlý bulundu (p=0.028). On dört (%48.3) olguda ek hastalýk varlýðý mevcuttu. Ek hastalýk sayýsý mortalite ile iliþkili bulundu (p=0.049). Fournier gangreni skorlama indeksi ve UFGSÝ puanlarý Grup II olgularda istatistiksel olarak anlamlý yüksek bulundu (sýrasýyla p=0.002 ve 0.001). Uludað Fournier gangreni skorlama indeksi skorlama parametrelerinden Grup II olgularda yaralanan alan, vücut ýsýsý, nabýz sayýsý ve HCO3 puanlarý Grup I olgularýn puanlarýndan istatistiksel olarak anlamlý yüksek bulundu (p<0.05). Fournier gangreni skorlama indeksi ve UFGSÝ’nin mortalite tahminindeki sensitivitesi %100 iken, spesitifite oranlarý sýrasýyla %78.2 ve 73.9 idi.
TARTIÞMA: Fournier gangreni mortalitesinin öngörüsünde FGSÝ ve UFGSÝ oldukça etkindir. Çalýþmamýzda hastalýðýn yayýlýmý prognozda önemli bir parametre olarak görüldü. Hangi skorlama sistemi kullanýlýrsa kullanýlsýn UFGSÝ’deki hastalýðýn yayýlým parametresi mutlaka her olguda kullanýlmalýdýr.

Usefulness of FGSI and UFGSI scoring systems for predicting mortality in patients with Fournier’s gangrene: A multicenter study

BACKGROUND: This study aimed to evaluate the usefulness of Fournier’s gangrene scoring index (FGSI) and Uludag FGSI (UFGSI) for predicting mortality in patients with FG.
METHODS: Patients who underwent treatment and follow-up in the A division department of general surgery at two education and research hospitals between January 2012 and December 2015 were evaluated for mortality-related factors. The sensitivities of FGSI and UFGSI scoring systems for predicting mortality-related factors and disease prognosis were evaluated. Patients were grouped as survivors (Group I) or non-survivors (Group II).
RESULTS: In total, 29 patients were included in the study. The mean age (±SD) was 51.52±13.36 years. The mortality rate was 20.6% (six patients). Bacterial growth was observed in wound cultures of 17 patients (58.6%). Of the patients with bacterial growth, 11 (47.8%) were in Group I and six (100%) were in Group II. The presence of bacterial growth was significantly associated with mortality (p=0.028). Fourteen patients (48.3%) had comorbid conditions. The number of comorbid conditions was related (p=0.049). FGSI and UFGSI scores were significantly higher in Group II than in Group I (p=0.002 and p=0.001, respectively). Among UFGSI parameters, extent of disease, body temperature, pulse rate, and HCO3 values were significantly higher in Group II than in Group I (p<0.05). The FGSI and UFGSI scoring systems had 100% sensitivity and 78.2% and 73.9% specificity, respectively, for predicting mortality.
CONCLUSION: The FGSI and UFGSI scoring systems are valuable for predicting mortality in patients with FG. The extent of the disease was an important prognostic parameter in this study. Whichever scoring system is used, we suggest the use of the extent of disease score in UFGSI.