Predictive Factors for Mortality in Fournier's Gangrene: A Series of 59 Cases

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"Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección Cirugía de Urgencias, Servicio de Cirugía General 2, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Facultad de Enfermería, Universidad de Alicante, Alicante, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores predictivos de mortalidad en la gangrena de Fournier: serie de 59 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1498 "Ancho" => 1632 "Tamanyo" => 82668 ] ] "descripcion" => array:1 [ "en" => "ROC Area under the ROC curve for the model (top line) compared to UFGSI (middle line) and FGSIS (bottom line). The Sidak-adjusted P-value was: .003 (UFGSI model) and .001 (FGSIS model)." ] ] ] "textoCompleto" => "IntroductionFournier's gangrene (FG) is the polymicrobial necrotizing fasciitis of the perineum and genital area, which may be of colorectal, genitourinary, traumatic or idiopathic aetiology. It primarily affects males in their 50s to 70s who, in most cases, have predisposing factors. It requires a multidisciplinary treatment, including haemodynamic support in the intensive care unit (ICU), broad-spectrum antibiotic therapy and surgical debridement; occasionally, a colostomy, suprapubic cystostomy or orchiectomy is required. It has an elevated mortality rate (7%–75%); the validated predictive scales are complex and they can potentially be improved, since they are partially composed of variables that have not shown significant differences, thus reducing their predictive capacity.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a>The objective of this study is to analyse the prognostic factors of mortality, to create a new mortality predictive scale and to compare it to the already validated scales in a series of patients diagnosed with FG at our Emergency Department.MethodsAn observational, 15-year retrospective (1998–2012) cohort study was conducted at the Emergency Department of Hospital General Universitario Gregorio Marañón [Gregorio Marañón University General Hospital]. All patients clinically diagnosed with FG at the Emergency Department were included and the diagnosis was confirmed by a radiological test when applicable. Patients with an incomplete medical record were excluded. The independent variables collected were age, sex, associated comorbidities, Charlson comorbidity index (CCI) and age-adjusted Charlson comorbidity index (AACCI),<a class="elsevierStyleCrossRef" href="#bib0025">5</a> aetiology, vital signs (temperature, blood pressure, heart rate and respiratory rate), symptomatology, lab tests (the serum potassium values provided by our laboratory were considered normal in the range of 3.5–4.5mmol/L), systemic inflammatory response syndrome (SIRS) (defined as compliance with two or more of the following criteria: heart rate >90bpm, respiratory rate >20bpm or PaCO2 <32mmHg, temperature >38°C or <36°C, WBCs >12,000/mm3, <4000/mm3 or >10% of immature forms), severe sepsis (defined as sepsis [SIRS in addition to a clinically or microbiologically documented infection] associated with organ dysfunction, hypotension or tissue hypoperfusion). Organic dysfunction variables were: renal [creatinine >2mg/dL, >0.5mg/dL increase, or diuresis <0.5mL/kg/h for at least 2h], pulmonary [arterial hypoxaemia with PaO2/FIO2 <300], liver [platelets <100000/mm3, total bilirubin >2mg/dL, INR >1.5 or activated partial thromboplastin time >60s]. Arterial hypotension variables were: systolic blood pressure <90mmHg, mean blood pressure <70mmHg or decreased systolic blood pressure >40mmHg with respect to its baseline value. Tissue hypoperfusion variables were: lactate >3mmol/L),<a class="elsevierStyleCrossRef" href="#bib0030">6</a> stay at the ICU and use of vasoactive drugs, antibiotic used, affected body surface (ABS) measured in the normogram used in burned patients according to which penis (1%), each scrotum (1%), perineum (1%) and each ischiorectal fossa (2.5%),<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> surgical treatment associated with the debridement (colostomy, cystostomy or orchiectomy), microbiological culture and predictive scales (Fournier's Gangrene Severity Index Score [FGSIS] and Uludag Fournier's Gangrene Severity Index [UFGSI]) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0010">2–4</a> The dependent variable collected was mortality. Data collection was performed by reviewing medical records. The study protocol was approved by the Clinical Research Ethics Committee, which considered it a risk-free investigation given its retrospective nature in which no surgery was performed.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The statistical analysis was conducted with the SPSS® programme version 21.0 for Windows; the qualitative variables were defined by frequency and percentage and the quantitative variables were defined by the median and the 25–75 percentiles. The statistical tests employed in the univariate analysis were the chi-square test and Fisher's exact test for the qualitative variables and the Mann–Whitney and Kruskal–Wallis tests for the quantitative variables. The multivariate study was performed with a binary logistic regression model, including the significant variables in the univariate study (P=.05). The ROC area under the curve (AUC) was used to assess the discriminatory capacity of both the created model and the existing models, and the Sidak test from the statistical programme STATA for Windows was used to compare those capacities.ResultsOf the 59 enrolled patients, 53 were males (90%) and 6 were females (10%) with a median age of 68 years (51–73), and prior medical history in 48 of them (81%) included high blood pressure in 29 (49%), diabetes mellitus (DM) in 25 (36%), heart disease in 17 (29%), immunodepression in 14 (24%) (10 neoplasms, 2 chemotherapeutic treatments, 1 corticosteroid treatment and 1 acquired immunodeficiency syndrome), alcoholism in 12 (20%), smoking habit in 12 (20%), kidney disease in 9 (15%) and lung disease in 8 (14%), with a CCI of 1 (0; 3) and an AACCI of 4 (2; 6).The aetiology was colorectal in 31 cases (52%) (26 abscesses and 5 neoplasms), genitourinary in 12 (20%) (10 orchiepididymitis and 2 bladder neoplasms), traumatic in 9 (15%) (5 pressure ulcers, 2 bladder catheters, 1 traffic accident and 1 perforation by foreign body) and idiopathic in 7 (12%) cases.Of the 59 patients, 44 (74%) survived and 15 (25%) died with a hospital stay of 30 (18–56) and 8 (4–16) days, respectively. The aetiology in mortality cases was: colorectal in 5 cases (16%), genitourinary in 6 (50%), traumatic in 4 (44%) and idiopathic in 0 (0%), P=.095. The causes of death were: multiple organ failure in 12 (80%), pneumonia in 1, pulmonary thromboembolism in 1 and acute myocardial infarction in 1. The analysis of the mortality predictive factors is shown in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>. The multivariate analysis showed that the independent predictive variables were the presence of peripheral vascular disease, high serum potassium levels, and severe sepsis criteria (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). The model created was characterised by: constant of −7.566, adequate internal calibration (Hosmer–Lemeshow: P=.405) and an AUC of 0.850 (0.760–0.973).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The discriminatory capacity of the established scales is shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> and the comparison between the different models can be found in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionFG has a high mortality rate, from 7%–75% in classic series to 10%–40% in more recent series; in our case the mortality rate was 25% and its independent predictive factors were the presence of peripheral vascular disease, high serum potassium levels, and severe sepsis criteria.<a class="elsevierStyleCrossRefs" href="#bib0005">1,7–10</a>Multiple predictive factors have been described. Age has been rising progressively in the published series, and there are a growing number of studies showing that the patients who die are older, as in our case, although statistical significance was not achieved.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3,7–13</a>The most frequent comorbidities described have been chronic renal failure and neoplasms, while in our series the only frequent comorbidity was peripheral vascular disease. DM, despite being a common predisposing factor and being related to a reduced function of defence cells, has not been associated with a higher mortality rate in most series or in ours.<a class="elsevierStyleCrossRefs" href="#bib0045">9,12,14–18</a> The CCI and AACCI have been recently described as mortality predictive factors, as it occurred in our series.<a class="elsevierStyleCrossRefs" href="#bib0050">10,18</a>With respect to the aetiology, most series do not show differences among the various aetiologic groups (colorectal, genitourinary, traumatic and idiopathic); in this study, mortality was higher in the colorectal and traumatic cases but failed to reach a statistical significance.<a class="elsevierStyleCrossRefs" href="#bib0010">2,8,9,19</a>The laboratory parameters most frequently seen are low levels of haematocrit, bicarbonate and albumin as well as elevated levels of urea, creatinine, WBCs, sodium, potassium, alkaline phosphatase and lactate.<a class="elsevierStyleCrossRefs" href="#bib0045">9–13,19</a> In our series, mortality was significantly higher in patients with low levels of haemoglobin (P=.014) and haematocrit (P=.009) as well as elevated levels of alkaline phosphatase (P=.026), urea (P<.001), creatinine (P=.032) and potassium (P=.012), which reflects the important role that renal failure plays in the prediction of mortality.A delay in treatment should result in a higher mortality rate. However, different series have shown that the latency period and a cut-off point of two days as the difference between early and late treatment proved to be predictive of mortality, whereas in other series, as in ours, this did not occur.<a class="elsevierStyleCrossRefs" href="#bib0005">1,9,11,13,19</a>Performing a derivative colostomy or cystostomy, just as in our series, has not shown any prognostic value.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2,7,9,12,19,20</a>In the microbiological cultures, the different groups (gram-positive, gram-negative aerobes and anaerobes) have not been correlated to mortality, just as in our series.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22</a>Regarding the ABS, its prognostic value is unclear, even though more and more series are showing a larger ABS in the deceased patients, like this series, although no significant differences are found.<a class="elsevierStyleCrossRefs" href="#bib0005">1,7–11,15,19</a>Some authors have described a higher mortality rate as the number of debridement procedures increases, arguing disease progression with a larger affected surface and sepsis; however, these data have not been corroborated in most series, similar to our series.<a class="elsevierStyleCrossRefs" href="#bib0015">3,7,11,12,15,19</a>Every prognostic scale should predict a certain event in the best and easiest way possible. In the case of FG, the primary event is mortality, for which there are two validated scales so far: FGSIS and UFGSI.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Laor created the FGSIS in 1995, modifying the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scale; he established a cut-off point so that, with FGSIS >9, the likelihood of mortality was 75%, and with FGSIS ≤9, the likelihood of survival was 78%.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Its predictive value and the cut-off point have been confirmed in most series.<a class="elsevierStyleCrossRefs" href="#bib0010">2,9–11,15,19</a> In our case, the FGSIS score was significantly higher in the patients who died, with an acceptable discriminatory capacity; however, even though the differences existing with the cut-off point of 9 were significant, the discriminatory capacity was better with a cut-off point of 6. In 2010, Yilmazlar created a new score (UFGSI) by adding two parameters (age and disease extension), improving the discriminatory capacity in his series but also making it more complex compared to FGSIS. Yilmazlar used a cut-off point of 9 according to which, when UFGSI was >9, the likelihood of mortality was 94%, and when UFGSI was ≤9, the likelihood of survival was 81%.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In our series, the discriminatory capacity of UFGSI slightly improved the discriminatory capacity of FGSIS; nevertheless, the cut-off point with the best discriminatory capacity was 11.The use of prognostic scales is important for various reasons:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(a)Modification of therapeutic behaviours: Yilmazlar suggested that when the UFGSI is >9, given that the likelihood of mortality was high, the case should be managed in the ICU whereas when the UFGSI was ≤9, the likelihood of survival was high and the ICU was rarely required, so unnecessary costs could be avoided, as well as the morbidity related to a stay in the ICU.<a class="elsevierStyleCrossRef" href="#bib0010">2</a></li><li class="elsevierStyleListItem" id="lsti0010">(b)Feedback and correction of both diagnostic and therapeutic errors in all patients, particularly in the patients who died even though their scale-based likelihood was low.</li></ul>The main problem with these scales lies in that their discriminatory capacity is reduced. Consequently, as some studies have shown, the scales could potentially be improved because they are made up of variables that fail to show significant differences between the patients who survive and those who die. This was similar to what happened in our series, where 5 out of 8 in the FGSIS and 7 out of 10 in the UFGSI were not significant.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10,15,19</a> The discriminatory capacity in our model was higher than in the FGSIS and UFGSI because, unlike them, all its parameters presented significant differences between the patients who survived and those who died.We consider that our study's main limitation is its retrospective nature and the small sample size, something that occurs in most of these studies due to the low incidence of FG.In conclusion, FG is a disease with low incidence and a high mortality rate, without an ideal mortality prediction model. We have created a predictive model whose factors were peripheral vascular disease, high serum potassium levels and severe sepsis criteria, with higher discriminatory capacity than in the models previously described. The purpose of this model would be to understand this disease better, to be able to identify mistakes in case of unexpected mortality and to improve survival; however, the model still needs to be validated in longer series.Contribution from the AuthorsAndrés García Marín: study design, data acquisition and collection, analysis and interpretation of results, article writing, critical review and approval of the final version.Fernando Turégano Fuentes: study design, analysis and interpretation of results, article writing, critical review and approval of the final version.Marta Cuadrado Ayuso: data acquisition and collection, article writing, critical review and approval of the final version.Juan Antonio Andueza Lillo, Juan Carlos Cano Ballesteros and Mercedes Pérez López: article writing, critical review and approval of the final version.Conflicts of InterestThe authors declare that they do not have any conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres409615" "titulo" => array:5 [ 0 => "Abstract" 1 => "Aims" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec385709" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres409614" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec385708" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Contribution from the Authors" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-20" "fechaAceptado" => "2014-03-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec385709" "palabras" => array:4 [ 0 => "Necrotizing fasciitis" 1 => "Fournier's gangrene" 2 => "Predictive factors" 3 => "Mortality" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec385708" "palabras" => array:4 [ 0 => "Fascitis necrosante" 1 => "Gangrena de Fournier" 2 => "Factores predictores" 3 => "Mortalidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "AimsFournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate. The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department. MethodsRetrospective analysis study between 1998 and 2012. ResultsOf the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; P=.023), haemoglobin (S 13; D 11; P=.014), haematocrit (S 37; D 31.4; P=.009), white blood cells (S 17,400; D 23,800; P=.023), serum urea (S 58; D 102; P=.001), creatinine (S 1.1; D 1.9; P=.032), potassium (S 3.7; D 4.4; P=.012) and alkaline phosphatase (S 92; D 133; P=.014). Predictive scores were: Charlson index (S 1; D 4; P=.013), severe sepsis criteria (S 16 [36%]; D 13 [86%]; P=.001), Fournier's Gangrene Severity Index Score (FGSIS) (S 4; D 7; P=.002) and Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; D 13; P=.004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760–0.973), higher than FGSIS (0.746 [0.601–0.981]) and UFGSI (0.760 [0.617–0.904]). ConclusionsFG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivosLa gangrena de Fournier (GF) es la fascitis necrosante del periné y área genital que presenta una elevada mortalidad. El objetivo es analizar los factores pronósticos de mortalidad, creación de una nueva escala predictiva de mortalidad y compararla con las ya validadas en los pacientes diagnosticados de GF en nuestro Servicio de Urgencias. MétodosEstudio analítico, retrospectivo entre 1998 y 2012. ResultadosDe los 59 casos, 44 sobrevivieron (74%) (S) y 15 fallecieron (26%) (E). Se encontraron diferencias significativas en la vasculopatía periférica (S 5 [11%]; E 6 [40%]; p=0,023), haemoglobin (S 13; E 11; p=0,014), haematocrito (S 37; E 31,4; p=0,009), leucocitos (S 17.400; E 23.800; p=0,023), urea (S 58; E 102; p<0,001), creatinina (S 1,1; E 1,9; p=0,032), potasio (S 3,7; E 4,4; p=0,012) y fosfatasa alcalina (S 92; E 133; p=0,014). Escalas predictivas: índice de Charlson (S 1; E 4; p=0,013), criterios de sepsis grave (S 16 [36%]; E 13 [86%]; p=0,001), Fournier's gangrene severity index score (FGSIS) (S 4; E 7; p=0,002) y Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; E 13; p=0,004). Los factores predictores independientes fueron la vasculopatía periférica, el potasio sérico y criterios de sepsis grave, creando un modelo con área bajo la curva de 0,850 (0,760-0,973) superior al FGSIS (0,746 [0,601-0,981]) y al UFGSI (0,760 [0,617-0,904]). ConclusionesLa GF presentó una tasa de mortalidad elevada cuyos factores predictores independientes fueron la vasculopatía periférica, el potasio sérico y criterios de sepsis grave, creando un modelo con una capacidad discriminativa superior al resto." ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: García Marín A, Turégano Fuentes F, Cuadrado Ayuso M, Andueza Lillo JA, Cano Ballesteros JC, Pérez López M. Factores predictivos de mortalidad en la gangrena de Fournier: serie de 59 casos. Cir Esp. 2015;93:12–17." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Partial presentation at the XIX Reunión Nacional de Cirugía [XIX National Surgery Meeting] (Burgos, 23–25 October 2013)." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1498 "Ancho" => 1632 "Tamanyo" => 82668 ] ] "descripcion" => array:1 [ "en" => "ROC Area under the ROC curve for the model (top line) compared to UFGSI (middle line) and FGSIS (bottom line). The Sidak-adjusted P-value was: .003 (UFGSI model) and .001 (FGSIS model)." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "A, Fournier's Gangrene Severity Index Score; A+B+C: Uludag Fournier's Gangrene Severity; ARF, acute renal failure; Cr, creatinine; HR, heart rate; Ht, haematocrit; RR, respiratory rate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+4 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top">(A) Physiological variable</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Temperature (°C) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39–40.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.5–38.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36–38.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34–35.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32–33.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30–31.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><29.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140–179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110–139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70–109 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55–69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40–54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35–49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25–34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12–24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10–11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6–9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sodium (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160–179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155–159 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150–154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130–149 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120–129 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110–119 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><110 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cr (mg/dL) (x2 in ARF) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2–3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5–1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6–1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ht (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50–59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46–49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30–45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20–29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">WBC (×1000/mm3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20–39.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15–19.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3–14.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1–2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Venous bicarbonate (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41–51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32–40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22–31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18–21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15–17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top">(B) Dissemination variable</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top">Anorectal area, perineum or scrotum/vulva: +1; pubic area: +2; ischiorectal or gluteal area: +6.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top">(C) Age variable: <60 years (+0) and ≥ 60 years (+1).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab638164.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Fournier's Gangrene Severity Index." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "GNB, gram-negative bacilli; GPC, gram-positive cocci; LP, latency period (onset of symptoms until diagnosis); SS, severe sepsis; SIRS, systemic inflammatory response syndrome." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors (n=44) n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Exitus (n=15) n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male/female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39/5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.518 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (22.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (46.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.077 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Lung disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.327 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Kidney disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (26.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.104 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (34.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.680 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SIRS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 (81.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (93.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.268 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (86.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Early LP (<2 days) (n=22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (68.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (31.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.384 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Late LP (≥2 days) (n=37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (78.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (21.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vasoactive drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (22.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (53.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Colostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.591 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.547 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">GPC yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16/12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.649 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">GNB yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.650 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anaerobes yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22/6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.718 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab638166.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Univariate Analysis of Mortality-predictive Qualitative Variables." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "HR, heart rate; FGSIS, Fournier's Gangrene Severity Index Score; RR, respiratory rate; GGT, gamma-glutamyl transpeptidase; CI, Charlson index; AACI, age-adjusted Charlson index; UFGSI, Uludag Fournier's Gangrene Severity Index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors (n=44) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Death (n=15) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (49; 73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (61; 80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.064 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0; 2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0; 4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">AACI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1; 5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (4; 7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Systolic BP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112 (100; 135) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (90; 110) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HR<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (82; 105) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (80; 110) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.896 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RR<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (17; 20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (17; 21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.580 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Temperature<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.9 (37; 38.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (36.4; 38.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.827 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Haemoglobin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (10.6; 14.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (8.8; 12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Haematocrit<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5 (31.5; 41.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.4 (28.1; 35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">WBC<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17400 (14000; 25600) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23800 (18100; 35700) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Neutrophils \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.7 (85.2; 91.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.9 (85; 93.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.356 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (37; 75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (85; 147) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Creatinine<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 (0.9; 1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9 (1.1; 3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sodium<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133 (130; 137) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135 (131; 136) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.986 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Potassium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 (3.5; 4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 (3.9; 5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">GGT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (35; 94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (45; 69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.436 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Alkaline phosphatase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (58; 147) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133 (97; 239) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Venous bicarbonate<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.1 (22; 23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.4 (8.3; 23.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.134 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Latency period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2; 5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2; 5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.522 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Affected surface \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2.5; 5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 (3.5; 6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.255 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days of [cure] in the operating room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3; 7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1; 5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FGSIS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2; 6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5; 12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UFGSI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (6; 11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (9; 15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab638165.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "FGSIS components." ] ] ] "descripcion" => array:1 [ "en" => "Univariate Analysis of Mortality-predictive Quantitative Variables." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "TE, typical error; CI, confidence interval; OR, odds ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predictive variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Beta coefficient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Beta TE \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Peripheral vascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.598 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.960 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.433 (2.046–88.193) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Severe sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.297 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.971 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.947 (1.483–66.737) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Potassium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.092 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.515 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.034 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.980 (1.086–8.175) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab638167.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mortality Predictive Factors in Logistic Regression." ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "FGSIS, Fournier's Gangrene Severity Index Score; UFGSI, Uludag Fournier's Gangrene Severity Index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FGSIS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.746 (0.601–0.891) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FGSIS 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.686 (0.522–0.850) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FGSIS 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.642 (0.471–0.814) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FGSIS 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.666 (0.490–0.842) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FGSIS 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.633 (0.455–0.810) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UFGSI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.760 (0.617–0.904) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UFGSI 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.666 (0.515–0.818) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UFGSI 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.680 (0.519–0.841) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UFGSI 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.687 (0.520–0.854) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UFGSI 12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.667 (0.489–0.845) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab638168.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Discriminatory Capacity of the FGSIS and UFGSI and Their Cut-off Points." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiological characteristics of Fournier's gangrene: a report of 71 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Atilla Aridogan" 1 => "V. Izol" 2 => "D. Abat" 3 => "O. Karsli" 4 => "Y. Bayazit" 5 => "N. Satar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000342407" "Revista" => array:6 [ "tituloSerie" => "Urol Int" "fecha" => "2012" "volumen" => "89" "paginaInicial" => "457" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23076238" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fournier's gangrene: an analysis of 80 patients and a novel scoring system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Yilmazlar" 1 => "E. Ozturk" 2 => "H. Ozguc" 3 => "I. Ercan" 4 => "H. Vuruskan" 5 => "B. Oktay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10151-010-0592-1" "Revista" => array:6 [ "tituloSerie" => "Tech Coloproctol" "fecha" => "2010" "volumen" => "14" "paginaInicial" => "217" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20559857" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors affecting mortality of Fournier's gangrene: review of 70 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Ersay" 1 => "G. Yilmaz" 2 => "Y. Akgun" 3 => "Y. 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Predictive Factors for Mortality in Fournier's Gangrene: A Series of 59 Cases

Factores predictivos de mortalidad en la gangrena de Fournier: serie de 59 casos

Andrés García Marína,b,

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agmarin1980@gmail.com

Corresponding author.

, Fernando Turégano Fuentesc, Marta Cuadrado Ayusoc, Juan Antonio Andueza Lillod, Juan Carlos Cano Ballesterosd, Mercedes Pérez Lópeze

a Servicio de Cirugía de Urgencias, Hospital Universitario San Juan, Alicante, Spain

b Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, Spain

c Sección Cirugía de Urgencias, Servicio de Cirugía General 2, Hospital General Universitario Gregorio Marañón, Madrid, Spain

d Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain

e Facultad de Enfermería, Universidad de Alicante, Alicante, Spain

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It has an elevated mortality rate (7%&#8211;75%); the validated predictive scales are complex and they can potentially be improved, since they are partially composed of variables that have not shown significant differences, thus reducing their predictive capacity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of this study is to analyse the prognostic factors of mortality, to create a new mortality predictive scale and to compare it to the already validated scales in a series of patients diagnosed with FG at our Emergency Department.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">An observational, 15-year retrospective (1998&#8211;2012) cohort study was conducted at the Emergency Department of Hospital General Universitario Gregorio Mara&ntilde;&oacute;n [Gregorio Mara&ntilde;&oacute;n University General Hospital]. All patients clinically diagnosed with FG at the Emergency Department were included and the diagnosis was confirmed by a radiological test when applicable. Patients with an incomplete medical record were excluded. The independent variables collected were age, sex, associated comorbidities, Charlson comorbidity index (CCI) and age-adjusted Charlson comorbidity index (AACCI),<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> aetiology, vital signs (temperature, blood pressure, heart rate and respiratory rate), symptomatology, lab tests (the serum potassium values provided by our laboratory were considered normal in the range of 3.5&#8211;4.5<span class="elsevierStyleHsp" style=""></span>mmol/L), systemic inflammatory response syndrome (SIRS) (defined as compliance with two or more of the following criteria: heart rate &#62;90<span class="elsevierStyleHsp" style=""></span>bpm, respiratory rate &#62;20<span class="elsevierStyleHsp" style=""></span>bpm or PaCO<span class="elsevierStyleInf">2</span> &#60;32<span class="elsevierStyleHsp" style=""></span>mmHg, temperature &#62;38<span class="elsevierStyleHsp" style=""></span>&deg;C or &#60;36<span class="elsevierStyleHsp" style=""></span>&deg;C, WBCs &#62;12,000/mm<span class="elsevierStyleSup">3</span>, &#60;4000/mm<span class="elsevierStyleSup">3</span> or &#62;10% of immature forms), severe sepsis (defined as sepsis [SIRS in addition to a clinically or microbiologically documented infection] associated with organ dysfunction, hypotension or tissue hypoperfusion). Organic dysfunction variables were: renal [creatinine &#62;2<span class="elsevierStyleHsp" style=""></span>mg/dL, &#62;0.5<span class="elsevierStyleHsp" style=""></span>mg/dL increase, or diuresis &#60;0.5<span class="elsevierStyleHsp" style=""></span>mL/kg/h for at least 2<span class="elsevierStyleHsp" style=""></span>h], pulmonary [arterial hypoxaemia with PaO<span class="elsevierStyleInf">2</span>/FIO<span class="elsevierStyleInf">2</span> &#60;300], liver [platelets &#60;100<span class="elsevierStyleHsp" style=""></span>000/mm<span class="elsevierStyleSup">3</span>, total bilirubin &#62;2<span class="elsevierStyleHsp" style=""></span>mg/dL, INR &#62;1.5 or activated partial thromboplastin time &#62;60<span class="elsevierStyleHsp" style=""></span>s]. Arterial hypotension variables were: systolic blood pressure &#60;90<span class="elsevierStyleHsp" style=""></span>mmHg, mean blood pressure &#60;70<span class="elsevierStyleHsp" style=""></span>mmHg or decreased systolic blood pressure &#62;40<span class="elsevierStyleHsp" style=""></span>mmHg with respect to its baseline value. Tissue hypoperfusion variables were: lactate &#62;3<span class="elsevierStyleHsp" style=""></span>mmol/L),<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> stay at the ICU and use of vasoactive drugs, antibiotic used, affected body surface (ABS) measured in the normogram used in burned patients according to which penis (1%), each scrotum (1%), perineum (1%) and each ischiorectal fossa (2.5%),<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> surgical treatment associated with the debridement (colostomy, cystostomy or orchiectomy), microbiological culture and predictive scales (Fournier&#39;s Gangrene Severity Index Score [FGSIS] and Uludag Fournier&#39;s Gangrene Severity Index [UFGSI]) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> The dependent variable collected was mortality. Data collection was performed by reviewing medical records. The study protocol was approved by the Clinical Research Ethics Committee, which considered it a risk-free investigation given its retrospective nature in which no surgery was performed.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted with the SPSS<span class="elsevierStyleSup">&reg;</span> programme version 21.0 for Windows; the qualitative variables were defined by frequency and percentage and the quantitative variables were defined by the median and the 25&#8211;75 percentiles. The statistical tests employed in the univariate analysis were the chi-square test and Fisher&#39;s exact test for the qualitative variables and the Mann&#8211;Whitney and Kruskal&#8211;Wallis tests for the quantitative variables. The multivariate study was performed with a binary logistic regression model, including the significant variables in the univariate study (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.05). The ROC area under the curve (AUC) was used to assess the discriminatory capacity of both the created model and the existing models, and the Sidak test from the statistical programme STATA for Windows was used to compare those capacities.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">Of the 59 enrolled patients, 53 were males (90%) and 6 were females (10%) with a median age of 68 years (51&#8211;73), and prior medical history in 48 of them (81%) included high blood pressure in 29 (49%), diabetes mellitus (DM) in 25 (36%), heart disease in 17 (29%), immunodepression in 14 (24%) (10 neoplasms, 2 chemotherapeutic treatments, 1 corticosteroid treatment and 1 acquired immunodeficiency syndrome), alcoholism in 12 (20%), smoking habit in 12 (20%), kidney disease in 9 (15%) and lung disease in 8 (14%), with a CCI of 1 (0; 3) and an AACCI of 4 (2; 6).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The aetiology was colorectal in 31 cases (52%) (26 abscesses and 5 neoplasms), genitourinary in 12 (20%) (10 orchiepididymitis and 2 bladder neoplasms), traumatic in 9 (15%) (5 pressure ulcers, 2 bladder catheters, 1 traffic accident and 1 perforation by foreign body) and idiopathic in 7 (12%) cases.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of the 59 patients, 44 (74%) survived and 15 (25%) died with a hospital stay of 30 (18&#8211;56) and 8 (4&#8211;16) days, respectively. The aetiology in mortality cases was: colorectal in 5 cases (16%), genitourinary in 6 (50%), traumatic in 4 (44%) and idiopathic in 0 (0%), <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.095. The causes of death were: multiple organ failure in 12 (80%), pneumonia in 1, pulmonary thromboembolism in 1 and acute myocardial infarction in 1. The analysis of the mortality predictive factors is shown in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>. The multivariate analysis showed that the independent predictive variables were the presence of peripheral vascular disease, high serum potassium levels, and severe sepsis criteria (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). The model created was characterised by: constant of &#8722;7.566, adequate internal calibration (Hosmer&#8211;Lemeshow: <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.405) and an AUC of 0.850 (0.760&#8211;0.973).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The discriminatory capacity of the established scales is shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> and the comparison between the different models can be found in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">FG has a high mortality rate, from 7%&#8211;75% in classic series to 10%&#8211;40% in more recent series; in our case the mortality rate was 25% and its independent predictive factors were the presence of peripheral vascular disease, high serum potassium levels, and severe sepsis criteria.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7&#8211;10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Multiple predictive factors have been described. Age has been rising progressively in the published series, and there are a growing number of studies showing that the patients who die are older, as in our case, although statistical significance was not achieved.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3,7&#8211;13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The most frequent comorbidities described have been chronic renal failure and neoplasms, while in our series the only frequent comorbidity was peripheral vascular disease. DM, despite being a common predisposing factor and being related to a reduced function of defence cells, has not been associated with a higher mortality rate in most series or in ours.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,12,14&#8211;18</span></a> The CCI and AACCI have been recently described as mortality predictive factors, as it occurred in our series.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,18</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">With respect to the aetiology, most series do not show differences among the various aetiologic groups (colorectal, genitourinary, traumatic and idiopathic); in this study, mortality was higher in the colorectal and traumatic cases but failed to reach a statistical significance.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8,9,19</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The laboratory parameters most frequently seen are low levels of haematocrit, bicarbonate and albumin as well as elevated levels of urea, creatinine, WBCs, sodium, potassium, alkaline phosphatase and lactate.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;13,19</span></a> In our series, mortality was significantly higher in patients with low levels of haemoglobin (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.014) and haematocrit (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.009) as well as elevated levels of alkaline phosphatase (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.026), urea (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>.001), creatinine (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.032) and potassium (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.012), which reflects the important role that renal failure plays in the prediction of mortality.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A delay in treatment should result in a higher mortality rate. However, different series have shown that the latency period and a cut-off point of two days as the difference between early and late treatment proved to be predictive of mortality, whereas in other series, as in ours, this did not occur.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9,11,13,19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Performing a derivative colostomy or cystostomy, just as in our series, has not shown any prognostic value.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,7,9,12,19,20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In the microbiological cultures, the different groups (gram-positive, gram-negative aerobes and anaerobes) have not been correlated to mortality, just as in our series.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,22</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Regarding the ABS, its prognostic value is unclear, even though more and more series are showing a larger ABS in the deceased patients, like this series, although no significant differences are found.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7&#8211;11,15,19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Some authors have described a higher mortality rate as the number of debridement procedures increases, arguing disease progression with a larger affected surface and sepsis; however, these data have not been corroborated in most series, similar to our series.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,7,11,12,15,19</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Every prognostic scale should predict a certain event in the best and easiest way possible. In the case of FG, the primary event is mortality, for which there are two validated scales so far: FGSIS and UFGSI.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Laor created the FGSIS in 1995, modifying the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scale; he established a cut-off point so that, with FGSIS &#62;9, the likelihood of mortality was 75%, and with FGSIS &#8804;9, the likelihood of survival was 78%.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Its predictive value and the cut-off point have been confirmed in most series.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,9&#8211;11,15,19</span></a> In our case, the FGSIS score was significantly higher in the patients who died, with an acceptable discriminatory capacity; however, even though the differences existing with the cut-off point of 9 were significant, the discriminatory capacity was better with a cut-off point of 6. In 2010, Yilmazlar created a new score (UFGSI) by adding two parameters (age and disease extension), improving the discriminatory capacity in his series but also making it more complex compared to FGSIS. Yilmazlar used a cut-off point of 9 according to which, when UFGSI was &#62;9, the likelihood of mortality was 94%, and when UFGSI was &#8804;9, the likelihood of survival was 81%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In our series, the discriminatory capacity of UFGSI slightly improved the discriminatory capacity of FGSIS; nevertheless, the cut-off point with the best discriminatory capacity was 11.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The use of prognostic scales is important for various reasons:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">(a)</span><p id="par0115" class="elsevierStylePara elsevierViewall">Modification of therapeutic behaviours: Yilmazlar suggested that when the UFGSI is &#62;9, given that the likelihood of mortality was high, the case should be managed in the ICU whereas when the UFGSI was &#8804;9, the likelihood of survival was high and the ICU was rarely required, so unnecessary costs could be avoided, as well as the morbidity related to a stay in the ICU.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">(b)</span><p id="par0120" class="elsevierStylePara elsevierViewall">Feedback and correction of both diagnostic and therapeutic errors in all patients, particularly in the patients who died even though their scale-based likelihood was low.</p></li></ul></p><p id="par0125" class="elsevierStylePara elsevierViewall">The main problem with these scales lies in that their discriminatory capacity is reduced. Consequently, as some studies have shown, the scales could potentially be improved because they are made up of variables that fail to show significant differences between the patients who survive and those who die. This was similar to what happened in our series, where 5 out of 8 in the FGSIS and 7 out of 10 in the UFGSI were not significant.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10,15,19</span></a> The discriminatory capacity in our model was higher than in the FGSIS and UFGSI because, unlike them, all its parameters presented significant differences between the patients who survived and those who died.</p><p id="par0130" class="elsevierStylePara elsevierViewall">We consider that our study&#39;s main limitation is its retrospective nature and the small sample size, something that occurs in most of these studies due to the low incidence of FG.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion, FG is a disease with low incidence and a high mortality rate, without an ideal mortality prediction model. We have created a predictive model whose factors were peripheral vascular disease, high serum potassium levels and severe sepsis criteria, with higher discriminatory capacity than in the models previously described. The purpose of this model would be to understand this disease better, to be able to identify mistakes in case of unexpected mortality and to improve survival; however, the model still needs to be validated in longer series.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Contribution from the Authors</span><p id="par0140" class="elsevierStylePara elsevierViewall">Andr&eacute;s Garc&iacute;a Mar&iacute;n: study design, data acquisition and collection, analysis and interpretation of results, article writing, critical review and approval of the final version.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Fernando Tur&eacute;gano Fuentes: study design, analysis and interpretation of results, article writing, critical review and approval of the final version.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Marta Cuadrado Ayuso: data acquisition and collection, article writing, critical review and approval of the final version.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Juan Antonio Andueza Lillo, Juan Carlos Cano Ballesteros and Mercedes P&eacute;rez L&oacute;pez: article writing, critical review and approval of the final version.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of Interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>"
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    "fechaRecibido" => "2014-01-20"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Necrotizing fasciitis"
            1 => "Fournier&#39;s gangrene"
            2 => "Predictive factors"
            3 => "Mortality"
          ]
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Fascitis necrosante"
            1 => "Gangrena de Fournier"
            2 => "Factores predictores"
            3 => "Mortalidad"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Aims</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fournier&#39;s gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate. The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis study between 1998 and 2012.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.023), haemoglobin (S 13; D 11; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.014), haematocrit (S 37; D 31.4; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.009), white blood cells (S 17,400; D 23,800; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.023), serum urea (S 58; D 102; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001), creatinine (S 1.1; D 1.9; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.032), potassium (S 3.7; D 4.4; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.012) and alkaline phosphatase (S 92; D 133; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.014). Predictive scores were: Charlson index (S 1; D 4; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.013), severe sepsis criteria (S 16 [36%]; D 13 [86%]; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001), Fournier&#39;s Gangrene Severity Index Score (FGSIS) (S 4; D 7; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.002) and Uludag Fournier&#39;s Gangrene Severity Index (UFGSI) (S 9; D 13; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760&#8211;0.973), higher than FGSIS (0.746 [0.601&#8211;0.981]) and UFGSI (0.760 [0.617&#8211;0.904]).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described.</p>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La gangrena de Fournier (GF) es la fascitis necrosante del perin&eacute; y &aacute;rea genital que presenta una elevada mortalidad. El objetivo es analizar los factores pron&oacute;sticos de mortalidad, creaci&oacute;n de una nueva escala predictiva de mortalidad y compararla con las ya validadas en los pacientes diagnosticados de GF en nuestro Servicio de Urgencias.</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&eacute;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio anal&iacute;tico, retrospectivo entre 1998 y 2012.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 59 casos, 44 sobrevivieron (74%) (S) y 15 fallecieron (26%) (E). Se encontraron diferencias significativas en la vasculopat&iacute;a perif&eacute;rica (S 5 [11%]; E 6 [40%]; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,023), haemoglobin (S 13; E 11; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,014), haematocrito (S 37; E 31,4; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,009), leucocitos (S 17.400; E 23.800; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,023), urea (S 58; E 102; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0,001), creatinina (S 1,1; E 1,9; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,032), potasio (S 3,7; E 4,4; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,012) y fosfatasa alcalina (S 92; E 133; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,014). Escalas predictivas: &iacute;ndice de Charlson (S 1; E 4; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,013), criterios de sepsis grave (S 16 [36%]; E 13 [86%]; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001), Fournier&#39;s gangrene severity index score (FGSIS) (S 4; E 7; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002) y Uludag Fournier&#39;s Gangrene Severity Index (UFGSI) (S 9; E 13; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,004). Los factores predictores independientes fueron la vasculopat&iacute;a perif&eacute;rica, el potasio s&eacute;rico y criterios de sepsis grave, creando un modelo con &aacute;rea bajo la curva de 0,850 (0,760-0,973) superior al FGSIS (0,746 [0,601-0,981]) y al UFGSI (0,760 [0,617-0,904]).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La GF present&oacute; una tasa de mortalidad elevada cuyos factores predictores independientes fueron la vasculopat&iacute;a perif&eacute;rica, el potasio s&eacute;rico y criterios de sepsis grave, creando un modelo con una capacidad discriminativa superior al resto.</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Garc&iacute;a Mar&iacute;n A, Tur&eacute;gano Fuentes F, Cuadrado Ayuso M, Andueza Lillo JA, Cano Ballesteros JC, P&eacute;rez L&oacute;pez M. Factores predictivos de mortalidad en la gangrena de Fournier: serie de 59 casos. Cir Esp. 2015;93:12&#8211;17.</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Partial presentation at the XIX Reuni&oacute;n Nacional de Cirug&iacute;a [XIX National Surgery Meeting] (Burgos, 23&#8211;25 October 2013).</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ROC Area under the ROC curve for the model (top line) compared to UFGSI (middle line) and FGSIS (bottom line). The Sidak-adjusted <span class="elsevierStyleItalic">P</span>-value was: .003 (UFGSI model) and .001 (FGSIS model).</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A, Fournier&#39;s Gangrene Severity Index Score; A<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>B<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>C: Uludag Fournier&#39;s Gangrene Severity; ARF, acute renal failure; Cr, creatinine; HR, heart rate; Ht, haematocrit; RR, respiratory rate.</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">+4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="10" align="left" valign="top"><span class="elsevierStyleItalic">(A) Physiological variable</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Temperature (&deg;C)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#8211;40.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38.5&#8211;38.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#8211;38.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#8211;35.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#8211;33.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#8211;31.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;29.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&#8211;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110&#8211;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#8211;109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#8211;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#8211;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#8211;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#8211;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#8211;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#8211;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#8211;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sodium (mmol/L)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160&#8211;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&#8211;159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&#8211;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#8211;149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&#8211;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110&#8211;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cr (mg/dL) (<span class="elsevierStyleItalic">x</span><span class="elsevierStyleSup">2</span> in ARF)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;3.5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#8211;3.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.5&#8211;1.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.6&#8211;1.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ht (%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#8211;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#8211;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#8211;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#8211;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WBC (&times;1000/mm<span class="elsevierStyleSup">3</span>)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#8211;39.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#8211;19.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#8211;14.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#8211;2.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Venous bicarbonate (mmol/L)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#8211;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#8211;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#8211;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#8211;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#8211;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="10" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="10" align="left" valign="top"><span class="elsevierStyleItalic">(B) Dissemination variable</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="10" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anorectal area, perineum or scrotum/vulva: +1; pubic area: +2; ischiorectal or gluteal area: +6.</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="10" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="10" align="left" valign="top"><span class="elsevierStyleItalic">(C) Age variable:</span> &#60;<span class="elsevierStyleItalic">60 years (+0) and &#8805; 60 years (+1).</span></td></tr></tbody></table>
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">GNB, gram-negative bacilli; GPC, gram-positive cocci; LP, latency period (onset of symptoms until diagnosis); SS, severe sepsis; SIRS, systemic inflammatory response syndrome.</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>44) n (%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Exitus (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) n (%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Male/female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39/5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14/1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.518&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 (22.7)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 (46.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lung disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 (11.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 (20)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 (11.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 (26.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 (34.1)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 (40)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.680&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Vascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 (11.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 (40)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SIRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 (81.8)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 (93.3)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 (36.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 (86.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Early LP (&#60;2 days) (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 (68.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 (31.8)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.384&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Late LP (&#8805;2 days) (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>37)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 (78.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 (21.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Vasoactive drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 (22.7)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 (53.3)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Colostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 (18.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 (13.3)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.591&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Urostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 (4.5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 (6.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.547&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">GPC yes/no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16/12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3/2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.649&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">GNB yes/no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19/9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4/1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Anaerobes yes/no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22/6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4/1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.718&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab638166.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Univariate Analysis of Mortality-predictive Qualitative Variables.</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">HR, heart rate; FGSIS, Fournier&#39;s Gangrene Severity Index Score; RR, respiratory rate; GGT, gamma-glutamyl transpeptidase; CI, Charlson index; AACI, age-adjusted Charlson index; UFGSI, Uludag Fournier&#39;s Gangrene Severity Index.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>44)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Death (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 (49; 73)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 (61; 80)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.064&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 (0; 2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 (0; 4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AACI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 (1; 5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 (4; 7)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Systolic BP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112 (100; 135)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 (90; 110)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HR<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 (82; 105)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 (80; 110)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.896&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RR<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 (17; 20)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 (17; 21)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.580&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Temperature<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37.9 (37; 38.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 (36.4; 38.5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.827&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Haemoglobin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 (10.6; 14.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 (8.8; 12)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Haematocrit<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37.5 (31.5; 41.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31.4 (28.1; 35)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">WBC<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>400 (14<span class="elsevierStyleHsp" style=""></span>000; 25<span class="elsevierStyleHsp" style=""></span>600)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23<span class="elsevierStyleHsp" style=""></span>800 (18<span class="elsevierStyleHsp" style=""></span>100; 35<span class="elsevierStyleHsp" style=""></span>700)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Neutrophils&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88.7 (85.2; 91.7)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91.9 (85; 93.5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Urea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 (37; 75)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102 (85; 147)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;.001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Creatinine<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.1 (0.9; 1.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.9 (1.1; 3.9)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sodium<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133 (130; 137)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135 (131; 136)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.986&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Potassium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3.7 (3.5; 4.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4.4 (3.9; 5.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">GGT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 (35; 94)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 (45; 69)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.436&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Alkaline phosphatase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 (58; 147)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133 (97; 239)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Venous bicarbonate<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22.1 (22; 23)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21.4 (8.3; 23.5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Latency period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 (2; 5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 (2; 5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Affected surface&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 (2.5; 5.7)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4.5 (3.5; 6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.255&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Days of [cure] in the operating room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 (3; 7)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 (1; 5)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FGSIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 (2; 6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 (5; 12)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">UFGSI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 (6; 11)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 (9; 15)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">FGSIS components.</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Univariate Analysis of Mortality-predictive Quantitative Variables.</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">TE, typical error; CI, confidence interval; OR, odds ratio.</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predictive variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Beta coefficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Beta TE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Peripheral vascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.598&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.960&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13.433 (2.046&#8211;88.193)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Severe sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.297&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9.947 (1.483&#8211;66.737)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Potassium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.515&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">.034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.980 (1.086&#8211;8.175)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Mortality Predictive Factors in Logistic Regression.</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">FGSIS, Fournier&#39;s Gangrene Severity Index Score; UFGSI, Uludag Fournier&#39;s Gangrene Severity Index.</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">FGSIS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.746 (0.601&#8211;0.891)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FGSIS 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.686 (0.522&#8211;0.850)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FGSIS 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.642 (0.471&#8211;0.814)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FGSIS 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.666 (0.490&#8211;0.842)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FGSIS 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.633 (0.455&#8211;0.810)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">UFGSI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.760 (0.617&#8211;0.904)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">UFGSI 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.666 (0.515&#8211;0.818)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">UFGSI 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.680 (0.519&#8211;0.841)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">UFGSI 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.687 (0.520&#8211;0.854)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">UFGSI 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.667 (0.489&#8211;0.845)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Discriminatory Capacity of the FGSIS and UFGSI and Their Cut-off Points.</p>"
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      ]
    ]
    "bibliografia" => array:2 [
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Article information

ISSN: 21735077
Original language: English

DOI:10.1016/j.cireng.2014.03.013

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	0	5
2024 October	26	5	31
2024 September	40	4	44
2024 August	31	9	40
2024 July	18	5	23
2024 June	15	1	16
2024 May	32	3	35
2024 April	23	9	32
2024 March	41	5	46
2024 February	17	4	21
2024 January	22	1	23
2023 December	29	6	35
2023 November	44	3	47
2023 October	41	6	47
2023 September	18	1	19
2023 August	14	1	15
2023 July	12	9	21
2023 June	13	3	16
2023 May	12	2	14
2023 April	14	2	16
2023 March	14	3	17
2023 February	23	6	29
2023 January	11	1	12
2022 December	23	7	30
2022 November	19	5	24
2022 October	26	19	45
2022 September	45	8	53
2022 August	22	10	32
2022 July	32	13	45
2022 June	16	5	21
2022 May	53	6	59
2022 April	27	9	36
2022 March	37	11	48
2022 February	24	14	38
2022 January	25	4	29
2021 December	61	18	79
2021 November	23	11	34
2021 October	47	12	59
2021 September	52	11	63
2021 August	31	11	42
2021 July	16	9	25
2021 June	25	11	36
2021 May	41	12	53
2021 April	77	22	99
2021 March	51	8	59
2021 February	50	14	64
2021 January	49	12	61
2020 December	45	7	52
2020 November	24	4	28
2020 October	28	2	30
2020 September	40	12	52
2020 August	23	24	47
2020 July	32	14	46
2020 June	19	6	25
2020 May	27	8	35
2020 April	15	5	20
2020 March	31	7	38
2020 February	19	2	21
2020 January	17	2	19
2019 December	26	9	35
2019 November	21	9	30
2019 October	27	4	31
2019 September	24	10	34
2019 August	29	0	29
2019 July	37	26	63
2019 June	91	24	115
2019 May	182	58	240
2019 April	86	25	111
2019 March	20	11	31
2019 February	27	15	42
2019 January	10	8	18
2018 December	22	5	27
2018 November	25	1	26
2018 October	46	10	56
2018 September	23	4	27
2018 August	20	1	21
2018 July	20	5	25
2018 June	10	0	10
2018 May	27	2	29
2018 April	23	9	32
2018 March	20	1	21
2018 February	13	0	13
2018 January	29	2	31
2017 December	14	1	15
2017 November	25	3	28
2017 October	25	0	25
2017 September	18	0	18
2017 August	19	1	20
2017 July	13	2	15
2017 June	23	4	27
2017 May	27	2	29
2017 April	24	4	28
2017 March	33	24	57
2017 February	30	11	41
2017 January	21	4	25
2016 December	31	6	37
2016 November	36	5	41
2016 October	52	10	62
2016 September	32	9	41
2016 August	46	9	55
2016 July	24	4	28
2016 June	30	11	41
2016 May	40	15	55
2016 April	30	10	40
2016 March	28	19	47
2016 February	28	17	45
2016 January	35	23	58
2015 December	31	12	43
2015 November	31	13	44
2015 October	35	13	48
2015 September	24	14	38
2015 August	22	5	27
2015 July	27	12	39
2015 June	14	8	22
2015 May	25	11	36
2015 April	18	6	24
2015 March	3	1	4
2015 February	10	3	13

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