Ulus Travma Acil Cerrahi Derg. 2023; 29(11): 1242-1247 | DOI: 10.14744/tjtes.2023.08903

The role of C-reactive protein albumin ratio for predicting mortality in patients with Fournier’s gangrene

Halit Özgül, Yunus Uzmay
Department of General Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya-Türkiye

BACKGROUND: Fournier’s gangrene (FG) is a rapidly progressing and life-threatening necrotizing fasciitis of the genital and perineal regions. To estimate the mortality rate associated with FG, Laor et al. developed the FG severity index (FGSI), an index with proven prognostic significance. On the other hand, the C-reactive protein (CRP)/albumin (CAR) ratio is a proven objective marker of inflam-matory response. In light of the foregoing, the objective of this study is to assess the prognostic value of the CAR ratio in predicting mortality in patients with FG in comparison with FGSI.
METHODS: This retrospective study consisted of 58 patients who were operated on for FG between 2019 and 2022. Research data were obtained from electronic and paper patient files, surgery notes, clinical follow-up forms, anamnesis, intensive care forms, and laboratory test results obtained from the hospital automation system. The clinical course of each patient was reviewed based on these records. The relationships between patients’ CAR ratios and their demographic and clinical characteristics, including age, gender, and comorbidities, whether ostomy was performed, length of hospital stay, growth in wound culture, isolated bacterial species, FGSI scores, and laboratory test results (hemoglobin, sodium, potassium, bicarbonate, glucose, blood urea nitrogen (BUN), creatinine, albumin, and CRP levels, white blood cell counts, hematocrit values, glucose-to-potassium, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-CRP ratios) and the prognostic power of CAR ratio in predicting the mortality associated with FG were investigated.
RESULTS: The mean age of the study group, 45 male and 13 female, was 57 (min. 17, max. 85) years. The most common predisposing factor was diabetes mellitus (DM), which was present in 32 (55.1%) patients. The most common symptoms at admission were erythema (89.6%), swelling/hardening (82.7%), pain (41.3%), fever (31%), and purulent discharge (37.9%). Of the 58 patients included in the study, six had died. The most common comorbidity, second to DM (55.1%), was cardiovascular disease (39.6%). The median ages of patients who had died and survived were 60 (min. 56, max. 85) and 56 (min. 18, max. 80) years, respectively. CAR ratio effectively differentiated FG patients who had survived from those who had died (area under the curve [AUC]: 0.907 [0.824–0.984]). The CAR ratio cutoff value of 2.8 effectively differentiated FG patients and FSGI scores who had survived from those who had died (AUC: 0.904 [0.823–0.992]).
CONCLUSION: The study findings demonstrated that the CAR ratio might serve as an effective biomarker in predicting the mortal-ity associated with FG.

Keywords: Albumin, C-reactive protein; C-reactive protein albumin ratio; Fournier’s gangrene.

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Fournier gangreni hastalarýnda mortaliteyi öngörmede c-reaktif protein albumin oranýnýn rolü

Halit Özgül, Yunus Uzmay
Saðlýk Bilimleri Üniversitesi Antalya Eðitim Araþtýrma Hastahanesi, Genel Cerrahi Kliniði, Antalya, Türkiye

AMAÇ: Fournier kangreni genital ve perineal bölgelerin hýzla ilerleyen ve hayatý tehdit eden nekrotizan fasiitidir. Fournier kangreni ile iliþkili ölüm oranýný tahmin etmek için Laor ve ark. Kanýtlanmýþ prognostik önemi olan bir indeks olan Fournier's Gangrene Severity Index'i (FGSI) geliþtirdi.C-reaktif protein/albümin (CAR) inflamatuar bir belirteç olup, birçok çalýþmada prognoz ve taný üzerinde belirleyici etkiye sahip olduðu bildirilmiþti. Çalýþmamýz Fournier Gangrenli hastalarda mortaliteyi öngörmede CAR oranýnýn prognostik deðerini belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþma, 2019-2022 yýllarý arasýnda Fournier gangreni nedeniyle opere edilen 58 hastayý içermektedir. Araþtýr-ma verileri, hastane otomasyon sisteminden alýnan elektronik ve kaðýt hasta dosyalarý, ameliyat notlarý, klinik takip formlarý, anamnez, yoðun bakým formlarý ve laboratuvar test sonuçlarýndan elde edildi. Hastalarýn CAR oranlarý ile yaþ, cinsiyet, komorbiditeler, ostomi yapýlýp yapýlmadýðý, hastanede kalýþ süresi, yara kültüründe üreme, izole edilen bakteri türleri, FGSI skorlarý ve laboratuvar test sonuçlarý CAR oranýnýn Fournier kangreni ile iliþkili mortaliteyi öngörmedeki prognostik rolü araþtýrýldý.
BULGULAR: Çalýþmada 45 erkek ve 13 kadýn olan çalýþma grubunun yaþ ortalamasý 57 (min.17, maks. 85) idi. En sýk predispozan faktör 32 (%55.1) diabetes mellitus idi. Baþvuru sýrasýnda en sýk görülen semptomlar eritem (%89.6), þiþlik/sertleþme (%82.7), aðrý (%41.3), ateþ (%31) ve cerahat içeren akýntý (%37.9) idi. Çalýþmaya dahil edilen 58 hastada mortalite görüldü. Diabetes mellitustan (%55.1) sonra en sýk görülen komorbidite kardi-yovasküler hastalýktý (%39.6). Ex olan ve olmayan hastalarýn medyan yaþlarý sýrasýyla 60 (min. 56, maks. 85) ve 56 (min. 18, maks. 80) idi. CAR oraný, mortal olmayan grupta Fournier kangren hastalarýný ölenlerden etkili bir þekilde ayýrt etti. 2.8'lik CAR oraný kesme deðeri, hayatta kalan Fournier kangren hastalarýný ölenlerden etkili bir þekilde ayýrdý.
SONUÇ: Çalýþma bulgularý, CAR oranýnýn Fournier kangreni ile iliþkili mortaliteyi tahmin etmede etkili bir biyobelirteç olarak hizmet edebileceðini göstermiþtir.

Anahtar Kelimeler: Albumin, C reaktif protein albumin oraný; C reaktif protein; fournier gangreni.

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