使用台灣健保資料庫去驗證年齡調整後的合併症指數只否可以用來對弗尼爾式壞疽的患者進行死亡風險評估
林宗彥1、陳奕宏2、蘇建州3、張育菁3、歐建慧、鄭裕生1
1國立成功大學附設醫院泌尿部、2國立成功大學附設醫院斗六分院泌尿部、3國立成功大學醫學院藥理所
Validation of the Age-adjusted Charlson comorbidity index to stratify the mortality risk of Fournier’s gangrene with Taiwan national health insurance research database
Tsung-Yen Lin1, I-Hung Cheng2, Chien-Chou Su3, Yu-Ching Chang3,Ou Chien-Hui1 Yu-Sheng Cheng1
1Department of Urology, Medical College and Hospital, National Cheng-Kung University, Tainan, and 2Division of Urology, Department of Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, and 3Institue of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Abstract
Purpose:
Fournier’s gangrene(FG) is known as the life-threatening disease with mortality rates ranging from 7.5 to 45%. Given the high mortality rate in those patients, it requires a proper risk stratification method to select high-risk patients for emergent surgical intervention and intensive care. This present study aims at the validation of the age-adjusted Charlson comorbidity index (ACCI) to stratify the risk of FG mortality using Taiwan national health insurance research database.
Materials and Methods:
From 2002 to 2016, the patients diagnosed with FG who received subsequent surgical intervention were enrolled from the National Health Research Institute Database of Taiwan. We collected the patients’ sequential clinical data and calculated their Charlson comorbidity index(CCI) and ACCI score. The ACCI scores were analyzed to identify risk factors of mortality. A nomogram was established with the Cox proportional hazards regression model to analyze the impact of ACCI on the FG prognosis.
Results:
Total of 2183 FG patients was enrolled in this study, with 7.97% mortality. After multivariate analysis, the significant risk factors of mortality were age (RR=1.03), ulcer diseases (RR=1.42), mild liver disease (RR=1.70), moderate or severe liver disease (RR=3.18), renal disease (RR=1.82), tumor (RR=1.84). For the perspective of CCI, the mortality rate was 3.44%, 8.08%, 12.48% in the subgroup of score 0-1, 2-3, ≧4, respectively. Regarding ACCI, the mortality rate was 1.41%, 2.6%, 12.67% in the subgroup of score ≤2, 3-4, ≥5, respectively.
Conclusions:
FG patients with high ACCI scores have a significantly higher risk of mortality. Our results indicated that ACCI could be a reliable tool to stratify the mortality risk of FG. The contributed risk factors of mortality in FG include age, ulcer diseases, liver disease, renal disease, and tumor.