分析造成佛尼爾氏壞疽病患死亡的預後因子

黃昱凱、黃奕燊、陳昱光、黃志賢

台北榮民總醫院 泌尿部

國立陽明交通大學醫學院泌尿學科、書田泌尿科學研究中心

Factors predicting mortality in patients with Fournier’s gangrene

Yu-Kai Huang, I-Shen Huang, Yu-Kuang Chen, William J Huang

Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University

Purpose:

Fournier's gangrene (FG) is a serious and fulminating infection of the soft parts of the perineum, involving the cutaneous, subcutaneous cellular tissue and the aponeuroses. The management of FG still poses a serious challenge in part due to the documented high morbidity and mortality rate. The present study sought to identify prognostic factors affecting mortality in FG patients.

Materials and Methods:

Between 2011 and 2020, 84 patients with a FG diagnosis made by computed tomography were enrolled. Data were obtained on demographics, comorbidities, and laboratory variables. Comparisons of relevant parameters were performed between non-survivors and survivors (defined as ≥ 3 months survival after the incident) through univariate and multivariate analysis.

Results:

The patients ranged in age from 18 to 100 years (mean age 67) and a male predominance (93%) was observed. The case fatality rate measured in our cohort was 20.2%. History of diabetes mellitus (DM), hypertension, cerebral vascular accident (CVA), coronary artery disease (CAD), peripheral arterial occlusive disease (PAOD), and cancer were present in 51%, 48%, 10%, 15%, 6%, and 20% cases respectively in our series. Overall, patients who received no operation (p < 0.001) and with underlying CAD (p = 0.017) are associated with higher mortality on univariate regression. While in multivariate analysis, serum procalcitonin level (p = 0.011) is determined as the only independent factor for predicting mortality in FG patients.

Conclusions:

Mortality remain high in FG patients despite optimal care and treatment. Serum procalcitonin level can be used as an surrogate measure for prediction of short-term mortality in 3 months.