Gangrena de Fournier: estudio de los factores pronósticos en 90 pacientes
Fournier gangrene: evaluation of prognostic factors in 90 patients
J. Medina Polo1
, A. Tejido Sánchez, F. de la Rosa Kehrmann, N. Felip Santamaría, M. Blanco Álvarez, O. Leiva Galvis
Autor para correspondencia
josemedinapolo@telefonica.net
Correspondencia autor: Dr. J. Medina Polo Servicio de Urología Hospital Universitario 12 de Octubre Avda. de Andalucía, s/n - 28041 Madrid Tel.: 913 908 121
Correspondencia autor: Dr. J. Medina Polo Servicio de Urología Hospital Universitario 12 de Octubre Avda. de Andalucía, s/n - 28041 Madrid Tel.: 913 908 121
Servicio de Urología. Hospital Universitario 12 de Octubre. Madrid.
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"apellidos" => "Medina Polo" "email" => array:1 [ 0 => "josemedinapolo@telefonica.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Tejido Sánchez" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "de la Rosa Kehrmann" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Felip Santamaría" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Blanco Álvarez" ] 5 => array:2 [ "nombre" => "O." "apellidos" => "Leiva Galvis" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urología. Hospital Universitario 12 de Octubre. Madrid." "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia autor: Dr. J. Medina Polo Servicio de Urología Hospital Universitario 12 de Octubre Avda. de Andalucía, s/n - 28041 Madrid Tel.: 913 908 121" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Fournier gangrene: evaluation of prognostic factors in 90 patients" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-09-01" "fechaAceptado" => "2008-10-01" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec88738" "palabras" => array:4 [ 0 => "Gangrena de Fournier" 1 => "Genital masculino" 2 => "Pronóstico" 3 => "Tratamiento" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec88737" "palabras" => array:4 [ 0 => "Fournier Gangrene" 1 => "Male genitalia" 2 => "Prognosis" 3 => "Treatment" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Este estudio evalúa los factores de riesgo y aquellas variables pronósticas que influyen en la supervivencia de los pacientes con gangrena de Fournier.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El estudio analiza retrospectivamente 90 pacientes con gangrena de Fournier tratados en nuestra institución entre 1975 y 2008. Evaluamos la edad media, enfermedades médicas asociadas, el origen de la fascitis necrotizante, el tiempo de evolución y la extensión de la fascitis necrotizante. Los resultados fueron valorados de acuerdo si el paciente sobrevivía o fallecía. En todos los pacientes se realizó desbridamiento quirúrgico extenso y recibieron terapia antibiótica parenteralmente.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La tasa de mortalidad fue del 34,4%. La edad media 63,0 años (rango 33-95), encontramos diferencias estadísticamente significativas entre la edad media de los supervivientes (edad media 59,84 años) y los fallecidos (edad media 70,20 años) (p=0,001). Presentaban alguna comorbilidad médica asociada 51 pacientes, la tasa de mortalidad fue mayor en estos pacientes, especialmente en aquellos que sufrían cáncer. Aunque la diabetes mellitus fue la patología más frecuentemente asociada, no se relacionó con un peor pronóstico de modo estadísticamente significativo. El origen de la infección se identificó en 62 pacientes, que presentaron una mayor mortalidad (p=0,015), la mortalidad cuando existía un origen urológico fue del 50%. Además, los pacientes que padecían una infección más extensa también mostraron un peor pronóstico.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La gangrena de Fournier tiene una alta tasa de mortalidad. Para evaluar las posibles variables pronósticas de esta en enfermedad son necesarios estudios con un elevado número de casos. La edad del paciente, la presencia de factores de riesgo, especialmente cáncer, un origen urológico de la infección y la extensión de la enfermedad tienen influencia en el pronóstico de la gangrena de Fournier.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study evaluates the risk factors and prognostic variables that affect survival of patients with gangrene of Fournier.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The study retrospectively analyzed 90 consecutive patients with gangrene of Fournier treated in our institution between 1975 and 2008. We evaluated the average age, associated systemic diseases, and the source, time of evolution and extent of necrotizing fasciitis. The outcomes were assessed according to whether the patient survived or died. All patients had aggressive surgical debridement, and received parenteral antibiotic therapy.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mortality rate was 34.4%. The mean age was 63.0 years (range 33-95), a statistically significant difference was found between the age of the survivors (median age, 59.84 years) and those who died (median age, 70.20 years) (p = 0.001). Medical comorbidities were identified in 51 patients; the death rate was higher in patients who had any medical disease, especially those who suffered from cancer. Although diabetes mellitus was the most common associated pathology, it was not related to a statistically significant worst prognosis. The source of the infection was identified in 62 patients, who showed a higher mortality (p = 0.015), the mortality rate when a urological source is identified was 50%. Moreover, patients suffering from a more extensive necrotizing infection showed a worst prognosis.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The gangrene of Fournier has a high mortality rate. Large series are required to study prognostic variables of this disease. The patient age, the presence of systemic risk factors, especially cancer, a urological source of infection and the extent of the disease have impact on the prognosis of Fournier’s gangrene.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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