FARUK KÜÇÜKDURMAZ, TAYFUN ŞAHİNKANAT, Mithat TEMİZER, SEFA RESİM

Fournier gangreninde mortaliteyi etkileyen faktörlerin değerlendirilmesi: 38 hastalık deneyimimiz

Amaç: Fournier gangreni (FG) tedavi yöntemlerindeki ilerlemelere rağmen yüksek mortalite ile sonuçlanan bir hastalıktır. Tedavi ve bakım hizmetlerindeki iyileşmeye rağmen mortalite oranlarının yüksek olması FG gelişimi için risk faktörlerinin ve mortaliteyi öngörecek parametre ve skorlama sistemlerinin belirlenmesi fikrini gündeme getirmiştir. Bu çalışmada FG hastalarında mortalite ve morbiditeyi öngörecek parametrelerin belirlenmesi ve ek hastalık varlığının prognozla ilişkisinin incelenmesi amaçlanmaktadır. Gereç ve Yöntemler: Çalışmaya 2010- 2015 yılları arasında kliniğimizde FG tanısı ile cerrahi ve medikal tedavi uygulanmış 38 hasta dahil edilmiştir.Hastaların yaş,başvuru süresi, komorbidite ve kolostomi varlığı gibi parametrelerinin yanı sıra vital bulguları,hastalığın yayılımı ve preoperatif kan değerleri retrospektif olarak kaydedildi. Bu değerlerin mortalite, yoğun bakım yatışı ve hospitalizasyon süreleri ile ilişkileri değerlendirildi. Bulgular: Toplam 38 hastanın 7’si ölmüş, 31 tanesi hayatta kalmıştır.Genel mortalite oranı %18.4’tür. Ölenlerin ortalama yaşı hayatta kalanlardan anlamlı olarak daha yüksekti (71.14±12.5 vs. 53.25±16.07, p=0.006).Ölen ve hayatta kalan hastalar arasında preoperatif laboratuar parametreleri açısından anlamlı farklılık izlenmedi.Diyabetes mellitus (DM), en sık karşılaşılan komorbid hastalıktı (n=17, %45). Gruplar arasında DM varlığı açısından anlamlı fark yoktu.Mortalite ve yoğun bakım yatış oranları ile DM varlığı arasında ilişki bulunamadı.Hastalığın şiddetini gösterdiği düşünülen Fournier Gangreni Şiddet İndeksi (FGSI) ile nötrofil lenfosit oranı (NLR) parametreleri arasında anlamlı ilişki bulunsa da (r:0.424, p:0.008), ölen ve hayatta kalan hastalar arasında her iki parametre açısından anlamlı farklılık izlenmedi. Sonuç: Çalışmamızda ileri yaş FG hastalarında mortaliteyi etkileyen bir faktör olarak belirlenmiştir.Buna karşın FGSI ve NLR gibi FG şiddeti ile ilişkili parametrelerle kötü prognoz arasında bir ilişki saptanamamıştır.Yine DM varlığı ile hastanede yatış süresi ve mortalite arasında anlamlı ilişki bulunamamıştır.

Anahtar Kelimeler:

Fournier gangreni, mortalite, fournier gangreni şiddet indeksi, nötrofil lenfosit oranı, diyabetes mellitus

Fournier’s gangrene: our experience with 38 patients and analysis of factors affecting mortality

Objectives: Despite increased developments in treatment modalities,mortality rates for Fournier’s gangrene (FG) are still high. High mortality rates necessiate the analysis of predisposing factors, laboratory parameters and development of scoring systems for FG. The aim of the present study was to evaluate parameters and scoring systems which may predict mortality and morbidity. Besides,the effect of comorbid conditions on outcomes of FG patients were investigated. Material-methods: A total of 38 patients admitted to our clinic between 2010 and 2015 with diagnosis of FG were included in the study. Surgical and medical treatments were performed for each patient.Medical records such as age, symptom duration, presence of comorbidites and colostomy application, vital signs, extent of the disease and preoperative laboratory parameters were recorded.All those parameters were analysed for their effects on mortality and morbidity. Results: Of 38 patients,7 were died and 31 were survived. Overall mortality rate was 18.4%. Mean age of deceased patients were significantly higher than that of survivors (71.14±12.5 vs. 53.25±16.07, p=0.006).Preoperative laboratory parameters were similar among groups. Diabetes mellitus (DM) was the most common comorbidity in patients (n=17, 45%). Groups were similar in terms of the presence of DM.Mortality and intensive care unit admission was not related to DM. Fournier’s Gangrene Severity Index (FGSI) and neutrophil to lymphocyte ratio (NLR),scoring systems which were thought the reflect severity of FG, were correlated with each other. However, those scores were not different between survivor and deceased patients. Conclusion: Advanced age was found to be related to mortality. However, FGSI and NLR was not associated with the worse prognosis. Also, DM was not associated with length of hospital stay and mortality.

Keywords:

Fournier’s gangrene, mortality, Fournier Gangrene Severity Index, neutrophil lymphocyte ratio, diabetes mellitus,

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