佛尼爾氏症的風險因子與臨床處置：18年的回顧性研究

徐任廷¹、鐘旭東¹、歐正峰¹

¹亞東紀念醫院 外科部 泌尿科

Risk Factors and Management of Fournier's Gangrene: An 18-Year Retrospective Study

Jen-Ting Hsu¹ , Shiu-Dong Chung¹, Chin fong Au¹

Division of Urology¹ Department of Surgery, Far Eastern Memorial Hospital, New Taipei City

Purpose: Fournier's gangrene is a rapid progressive and life-threatening disease. We aim to identify the risk factor of mortality and length of hospital stay and also share our experience in management of these patients over past 18 years.

Materials & Methods

We retrospectively collect data on patients diagnosed with Fournier's gangrene at our institution from 2006 to 2023. Mortality rate and length of hospital stay served as the primary outcomes. Patients were initially divided into two groups: survivors and non- survivors. We compared the risk factors between these two groups. Our analysis placed particular emphasis on demographic data, FGSI (Fournier Gangrene Severity Index), lactate levels, and the type of bacterial organisms. Additionally, we conducted a logistic regression analysis to explore the factors influencing prognosis.

Results

The overall average mortality rate among the 105 patients was 13.3%. The average FGSI was 5.3 for the survivors and 9.8 for non-survivors with statistical significance between two groups(p<0.001). Diabetes mellitus, the most common predisposing factor(54%), did not show significant differences between the two groups(p=0.529). Similarly, other factors, such as aging, hypertension, hyperlipidemia, cerebral vascular accident, coronary artery disease, liver cirrhosis, and smoking, also exhibited no significant differences between the two groups. Prognostic factors with a significant difference between the two groups were chronic kidney disease(15.2%, p=0.013), positive blood culture(p<0.001) and lactate levels exceeding 4(p=0.003). Logistic regression analysis also identified lactate levels as a significant factor affecting mortality rates(OR=1.338, 95%CI {1.027-1.743}, p=0.031). The average length of hospital stay was 23 days, and there was a significant positive correlation between the number of debridement and the length of hospital stay(p=0.001), although this did not affect the survival rate. The common isolated organisms were Escherichia coli(31%), Klebsiella pneumoniae(30%), and Staphylococcus spp.(26%).

Conclusions

High lactate levels, chronic kidney disease, and positive blood cultures are identified as crucial factors for predicting mortality in Fournier's gangrene. Despite diabetes mellitus is the most common predisposing factor but unrelated to mortality rates. The number of debridement influences the length of hospital stay. The most common bacterial species are Escherichia coli and Klebsiella pneumoniae.