Risk Factors for Mortality in Fournier's Gangrene: Necrotizing Fasciitis in Perineum and Perianal Region, a Single-hospital Experience

福尼爾氏壞疽：肛周及會陰部壞死性筋膜炎的死亡風險因子的單一醫院經驗

黃政義(Cheng-Yi Huang) ； 黃文詩(Wen-Shih Huang) ； 靳志堅(Chih-Chien Chin) ； 郭益宏(Yi-Hung Kuo) ； 謝孟樵(Meng-Chiao Hsieh) ； 何寬助(Kuan-Chu Ho)

《中華民國大腸直腸外科醫學會雜誌》 32卷3期 (2021/09) Pp. 97-104

https://doi.org/10.6312/SCRSTW.202109_32(3).11005

摘要

Objective. Fournier's gangrene (FG) is a rapidly progressing necrotizing fasciitis of the perineum, genital, and perianal areas associated with a high mortality rate. This study presented our experience with the risk factors for mortality among patients with FG. Materials and Methods. This was a retrospective study involving 85 patients treated for FG at a single hospital from January 2009 to December 2019. Several clinical and laboratory variables including the Simplified Fournier Gangrene Severe Index Score (SFGSI) were evaluated and correlated with mortality through univariate analysis and logistic regression. Results. Of the 85 patients, 70 (82.4%) were men, the mean age was 62.2 ± 15.4 (29-95) years, and the main comorbidities were diabetes mellitus in 48 patients (56.5%) and hypertension in 38 patients (44.7%). Six patients did not survive, and the mortality rate was 7.1%. Variables that presented an independent correlation with mortality were extension of the lesion to the abdominal wall (odds ratio (OR) = 78.0, confidence interval (CI) = 6.15-989.03; p = 0.044) and a comorbidity of liver cirrhosis (OR = 20.28, CI = 3.14-131.17; p = 0.022). Conclusion. FG extending to the abdominal wall and a comorbidity of liver cirrhosis are independent risk factors for mortality. The simplified form of the FGSI showed a correlation with mortality but was not an independent risk factor for mortality in this study.

關鍵字

Fournier's gangrene ； Risk factors ； Mortality rate ； Fasciitis

並列摘要

目的：福尼爾氏壞疽是會陰部，生殖器和肛周區域迅速發展且死亡率很高的壞死性筋膜炎。這篇研究呈現福尼爾氏壞疽死亡率的危險因素的探討與分析。方法：這是一項回顧性研究，收集從2009年1月到2019年12月在單一醫院治療的85名福尼爾氏壞疽患者。通過單變量分析和邏輯回歸，評估了臨床特徵、檢驗數據和簡化的福尼爾氏壞疽嚴重指數評分（SFGSI）與死亡率的關聯性。結果：在85位患者中，有70名（82.4%）為男性，平均年齡為62.2 ± 15.4（29－95）歲，主要合併症是糖尿病48位（56.5%）和高血壓38位（44.7%）。其中有6位患者沒有存活，死亡率為7.1%。統計結果顯示壞疽病變擴展至腹壁（OR = 78.0, CI = 6.15-989.03; p = 0.044）及肝硬化（OR = 20.28, CI = 3.14-131.17; p = 0.022）與死亡率有顯著相關。結論：福尼爾氏壞疽病變擴展至腹壁和肝硬化是導致死亡的獨立危險因子。簡化的福尼爾氏壞疽嚴重指數評分（SFGSI）與死亡率有相關性，在本研究中並無顯著意義。

並列關鍵字

福尼爾氏壞疽 ； 風險因子 ； 死亡率 ； 筋膜炎

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