Gangrena de Fournier: revisión de factores determinantes de mortalidad

Abstract

Recibido el 2 de octubre de 2015; aceptado el 12 de noviembre de 2015 Disponible en Internet el 24 de abril de 2016 PALABRAS CLAVEGangrena de Fournier; Mortalidad; Factores de pronóstico Resumen La gangrena de Fournier es una fascitis necrosante polimicrobiana que afecta el periné, el escroto y/o el área perianal con una tasa de mortalidad actual del 20% al 40%. El objetivo de esta revisión es describir los factores pronósticos de mortalidad reportados en la literatura mundial, para lo cual se realizó la búsqueda de artículos indexados en Medline, utilizando los respectivos términos MeSH para la búsqueda, así como una búsqueda manual de las referencias encontradas en los artículos primarios. Se reportan diversos factores con significación estadística; sin embargo, el índice de Laor predomina como herramienta de mayor significación a la hora de determinar la mortalidad de los pacientes. Mortality risk factors in Fournier gangrene. A literature reviewAbstract Fournier gangrene is a necrotizing fasciitis caused by facultative microorganisms that affects the perineal area, the scrotum or the perianal area. It has a 20% to 40% mortality. We performed a literature review to determine its determinants of mortality. Among all factors, the Laor index (which includes temperature, heart rate, respiratory rate, serum sodium, potassium and creatine, blood leukocyte count, packed red cell volume and bicarbonate) predominates as the best tool to assess mortality risk.

Fournier’s gangrene by perianal abscess

“…Fournier's gangrene is a relatively uncommon condition, with an estimated incidence of 1.6 cases per 100,000 men, 13 with a peak incidence between the fifth and sixth decades of life; however, the incidence is increasing due to the increase in the population's life expectancy. 9 In our sample of 31 patients with FG due to perianal abscess seen over a 6-year period, the vast majority of patients, 83.87%, consisted of male patients and the mean age was 53.51 ± 14.56 years, in line with the epidemiological profile of the reviewed studies. 4,6,7,9,13,14 Comorbidities comprise an important risk factor for the occurrence of FG, with DM2 being the condition with the great-est association in the literature.…”

“…9 In our sample of 31 patients with FG due to perianal abscess seen over a 6-year period, the vast majority of patients, 83.87%, consisted of male patients and the mean age was 53.51 ± 14.56 years, in line with the epidemiological profile of the reviewed studies. 4,6,7,9,13,14 Comorbidities comprise an important risk factor for the occurrence of FG, with DM2 being the condition with the great-est association in the literature. 3,4,7,15 When correlating DM2 to the mortality in FG due to perianal abscess, we demonstrated a p = 0.01941.…”

“…The mortality rate related to FG reported in the literature, from ancient times to the present day, is about 20%. 4,8,9 In our study, this rate was 22.58%. According to Tenorio et al, 8 late diagnosis and intervention have a high correlation with mortality.…”

“…Moreover, we realized that even with current therapeutic advances and a multidisciplinary approach, FG continues to show prolonged hospital length of stay and high mortality rates. 8,9,15 These data indicate the need for improvement in primary health care services, with training in the diagnosis of perianal abscesses, optimization of treatment and early referral of these patients to a specialist. Thus, there will be a reduction in the morbidity and mortality of this disease, since these are potentially preventable issues with an early intervention, either by identifying and draining of the abscess in the Basic Health Unit or through treatment at the tertiary level.…”

“…2 Despite the aggressive multidisciplinary and surgical treatment, mortality rates vary between 20% and 40% in most cases but can vary from 4% to 88%. 8,9 This high mortality rate is partly attributable to the aggressive nature of the infection and the underlying comorbidities. The mortality rates are 2 to 3-fold higher in diabetics, elderly patients and in patients with delayed treatment.…”