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Bowen D, Hughes T, Juliebø-Jones P, Somani B. Fournier's gangrene: a review of predictive scoring systems and practical guide for patient management. Ther Adv Infect Dis 2024; 11:20499361241238521. [PMID: 38510990 PMCID: PMC10952983 DOI: 10.1177/20499361241238521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
This article aims to provide a practical guide for patient management and an overview of the predictive scorings for Fournier's gangrene (FG) that are available to aid clinicians. A literature was performed reviewing currently used scoring systems for FG and presenting a practical guide for its management based on the available evidence. There are four specific scoring systems available for the assessment of FG although few other non-specific and generic tools also exist. These specific tools include Laboratory Risk Indicator for Necrotizing Fasciitis, Fournier's Gangrene Severity Index, Uludag Fournier's Gangrene Severity Index, and Simplified Fournier's Gangrene Severity Index and help calculate expected mortality. Our proposed algorithm covers primary assessment, resuscitative interventions, initial investigations, urgent care, post-operative care, and long-term follow-up. The management of the FG patient can be divided into initial resuscitation, surgical debridement, ongoing ward management with antibiotic therapy, wound reconstruction, and long-term follow-up. Each facet of care is vital and requires multidisciplinary team expertise for optimal outcomes. Whilst mortality continues to improve, it remains significant, reflecting the severe and life-threatening nature of FG. More research is certainly needed into how this care is individualised, and to ensure that long-term outcomes in FG include quality of life measures after discharge.
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Affiliation(s)
- Daniel Bowen
- Department of Urology, Mid and South Essex NHS Foundation Trust, Broomfield, UK
| | - Thomas Hughes
- Department of Urology, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | | | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
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Lin CL, Wu SY, Lai MW, Hsu CW, Chen WM, Jao AT, Chien CH, Hu CC, Chien RN, Yeh CT. Predicting Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients Receiving Finite Periods of Antiviral Therapy. Cancers (Basel) 2023; 15:3343. [PMID: 37444453 DOI: 10.3390/cancers15133343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is one of the most severe complications in chronic hepatitis B virus (HBV) infection. HCC can still develop in patients with chronic HBV (CHB) infection undergoing antiviral therapy. Several effective scoring systems for the prediction of HCC risk in CHB patients have been established. However, very few of them are designed for CHB patients receiving nucleos(t)ide analogues (NAs) therapy. Furthermore, none are available for HCC risk prediction in CHB patients receiving finite periods of antiviral therapy. METHODS This study enrolled 790 consecutive treatment-naïve patients with CHB infection who had visited our liver clinics from 2008 to 2012 for pretreatment assessment before receiving antiviral therapies. The treatments were provided at finite periods according to the National Health Insurance Policy in Taiwan. The last follow-up date was 31 December 2021. We analyzed the virological and clinical factors in these 790 CHB patients receiving finite periods of NA treatments and identified the most significant risk factors for HCC to establish a novel predictive scoring system. By using stepwise selection in a multivariate Cox proportional hazards model, we divided the patients into three risk groups. RESULTS Our predictive scoring system included five independent variables: genotype C (adjusted HR [aHR] = 2.23), NA-withdraw-related hepatitis relapse (aHR = 6.96), male (aHR = 4.19), liver cirrhosis (aHR = 11.14), and T1768A core promoter mutation (aHR = 3.21). This model revealed significant differences in HCC incidence among the three risk groups. The 5-year cumulative HCC risk significantly differed among the three risk groups (low risk: 1.33%, moderate risk: 4.99%, and high risk: 17.46%), with log-rank test p < 0.001. CONCLUSION Our predictive scoring system is a promising tool for the prediction of HCC in CHB patients receiving finite NA treatments. Genotype C, NA-withdraw-related hepatitis relapse, male gender, liver cirrhosis, and the T1768A HBV core promoter mutation were significant independent risk factors.
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Affiliation(s)
- Chih-Lang Lin
- Liver Research Center, Department of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
- College of Medicine, Chang Gung University, Taoyua 833, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei City 242, Taiwan
| | - Ming-Wei Lai
- College of Medicine, Chang Gung University, Taoyua 833, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan 833, Taiwan
- Division of Pediatric Gastroenterology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chao-Wei Hsu
- College of Medicine, Chang Gung University, Taoyua 833, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan 833, Taiwan
| | - Wan-Ming Chen
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan 833, Taiwan
- Division of Pediatric Gastroenterology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - An-Tzu Jao
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Cheng-Hung Chien
- Liver Research Center, Department of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
- College of Medicine, Chang Gung University, Taoyua 833, Taiwan
| | - Ching-Chih Hu
- Liver Research Center, Department of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
- College of Medicine, Chang Gung University, Taoyua 833, Taiwan
| | - Rong-Nan Chien
- College of Medicine, Chang Gung University, Taoyua 833, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan 833, Taiwan
| | - Chau-Ting Yeh
- College of Medicine, Chang Gung University, Taoyua 833, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital, Taoyuan 833, Taiwan
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Soong RS, Chen YC, Chou TC, Chiang PH, Chen WM, Chiang MF, Shia BC, Wu SY. A Novel Predictive Scoring System for 90-Day Mortality among Patients with Hepatocellular Cell Carcinoma Receiving Major Hepatectomy. Cancers (Basel) 2022; 14:cancers14061398. [PMID: 35326550 PMCID: PMC8945917 DOI: 10.3390/cancers14061398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Hepatocellular carcinoma (HCC) is a major malignancy correlated with many cancer-related deaths. Surgical intervention provides superior long-term survival; however, perioperative mortality is a major concern for clinicians while making treatment decisions, especially for major hepatectomy. Scoring systems for predicting 90-day mortality in patients with HCC undergoing major hepatectomy are not available. By using the stepwise selection of the multivariate Cox proportional hazards model, we divided the patients with HCC receiving major hepatectomy into four risk groups. The Chang Gung-PohAi predictive scoring system showed significant differences in the 90-day mortality rate among the four risk groups (very low risk: 2.42%, low risk: 4.09%, intermittent risk: 17.1%, and high risk 43.6%). The Chang Gung-PohAi predictive scoring system is a promising tool for predicting 90-day perioperative mortality in patients with HCC undergoing major hepatectomy. Abstract Purpose: Hepatocellular carcinoma (HCC) is a major malignancy and the common cause of cancer-related deaths. Surgical intervention provides superior long-term survival outcomes; however, perioperative mortality is a major concern for clinicians while making treatment decisions, especially for major hepatectomy. Scoring systems for predicting 90-day mortality in patients with HCC undergoing major hepatectomy are not available. Methods: This study used the Taiwan Cancer Registry Database that is linked to the National Health Insurance Research Database to analyze data of 60,250 patients with HCC who underwent major hepatectomy and determine risk factors to establish a novel predictive scoring system. By using the stepwise selection of the multivariate Cox proportional hazards model, we divided the patients with HCC undergoing major hepatectomy into four risk groups. Results: The Chang Gung-PohAi predictive scoring system exhibited significant differences in the 90-day mortality rate among the four risk groups (very low risk: 2.42%, low risk: 4.09%, intermittent risk: 17.1%, and high risk: 43.6%). Conclusion: The Chang Gung-PohAi predictive scoring system is a promising tool for predicting 90-day perioperative mortality in patients with HCC undergoing major hepatectomy.
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Affiliation(s)
- Ruey-Shyang Soong
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (R.-S.S.); (Y.-C.C.); (T.-C.C.); (P.-H.C.)
- Division of General Surgery, Chang Gung Medical College Taoyuan, Taoyuan 333, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yi-Chan Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (R.-S.S.); (Y.-C.C.); (T.-C.C.); (P.-H.C.)
| | - Ta-Chun Chou
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (R.-S.S.); (Y.-C.C.); (T.-C.C.); (P.-H.C.)
| | - Po-Hsing Chiang
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (R.-S.S.); (Y.-C.C.); (T.-C.C.); (P.-H.C.)
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, Taiwan; (W.-M.C.); (B.-C.S.)
| | - Ming-Feng Chiang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan;
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, Taiwan; (W.-M.C.); (B.-C.S.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 242, Taiwan; (W.-M.C.); (B.-C.S.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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Richter SE, Miller L, Needleman J, Uslan DZ, Bell D, Watson K, Humphries R, McKinnell JA. Risk Factors for Development of Carbapenem Resistance Among Gram-Negative Rods. Open Forum Infect Dis 2019; 6:ofz027. [PMID: 30863785 PMCID: PMC6405936 DOI: 10.1093/ofid/ofz027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/24/2018] [Accepted: 01/16/2019] [Indexed: 11/22/2022] Open
Abstract
Background Infections due to carbapenem-resistant Gram-negative rods (CR-GNR) are increasing in frequency and result in high morbidity and mortality. Appropriate initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay. Methods To determine risk factors for recovery on culture of CR-GNR, cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. Ertapenem resistance (ER-GNR) and antipseudomonal (nonertapenem) carbapenem resistance (ACR-GNR) patterns were analyzed separately. A total of 30951 GNR isolates from 12370 patients were analyzed, 563 of which were ER and 1307 of which were ACR. Results In multivariate analysis, risk factors for ER-GNR were renal disease, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) agent in the prior 30 days (c-statistic, 0.74). Risk factors for ACR-GNR were male sex, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (c-statistic, 0.76). Conclusions A straightforward scoring system derived from these models can be applied by providers to guide empiric antimicrobial therapy; it outperformed use of a standard hospital antibiogram in predicting infections with ER-GNR and ACR-GNR.
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Affiliation(s)
- Stefan E Richter
- Division of Cardiology, University of California, Los Angeles, Los Angeles, California.,NIH BD2K Center of Excellence, University of California, Los Angeles, Los Angeles, California
| | - Loren Miller
- Infectious Disease Clinical Outcome Research Unit, Los Angeles Biomedical Research Institute at Harbor-UCLA, University of California, Los Angeles, Los Angeles, California
| | - Jack Needleman
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California
| | - Daniel Z Uslan
- Division of Infectious Disease, University of California, Los Angeles, Los Angeles, California
| | - Douglas Bell
- Division of Internal Medicine, University of California, Los Angeles, Los Angeles, California
| | - Karol Watson
- Division of Cardiology, University of California, Los Angeles, Los Angeles, California.,NIH BD2K Center of Excellence, University of California, Los Angeles, Los Angeles, California
| | - Romney Humphries
- Division of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, California
| | - James A McKinnell
- Infectious Disease Clinical Outcome Research Unit, Los Angeles Biomedical Research Institute at Harbor-UCLA, University of California, Los Angeles, Los Angeles, California
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Ferenci P, Aires R, Ancuta I, Arohnson A, Cheinquer H, Delic D, Gschwantler M, Larrey D, Tallarico L, Schmitz M, Tatsch F, Ouzan D. A tool for selecting patients with a high probability of sustained virological response to peginterferon alfa-2a (40kD)/ribavirin. Liver Int 2014; 34:1550-9. [PMID: 24329937 DOI: 10.1111/liv.12439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/07/2013] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Pretreatment identification of patients likely to achieve a sustained virological response (SVR) with peginterferon alfa-2a/ribavirin would be useful for individualizing treatment choices. The aim of this analysis was to devise a simple scoring system to identify patients with high probability of achieving an SVR with peginterferon alfa-2a/ribavirin. METHODS Using data from 2109 Caucasian treatment-naive hepatitis C virus (HCV) genotype 1 mono-infected patients from the PROPHESYS cohorts, the relationship between favourable baseline characteristics and SVR was explored using generalized additive model analysis, and a scoring system was devised to predict SVR. RESULTS Points were assigned for: age (years) (≤35: 2; >35, ≤45: 1; >45: 0); body mass index (kg/m(2)) (≤20: 2; >20, ≤22: 1; >22: 0); HCV RNA (IU/ml) (≤100,000: 3; >100,000-400,000: 2; >400,000-800,000: 1; >800,000: 0); platelets (>150 ×10(9)/l: 1; ≤150 ×10(9)/l: 0); alanine aminotransferase [×upper limit of normal (ULN)] (>3: 1; ≤3: 0); serum aspartate aminotransferase (×ULN) (≤1: 1; >1: 0). 1029, 698 and 382 patients had scores of 0-2, 3-4 and ≥5, respectively, among whom SVR rates were 35.0, 54.9 and 76.7%. SVR in patients with scores ≥5 and undetectable HCV RNA by week 4 was 86.7%. The score was tested against two databases of patients who received peginterferon alfa-2a/ribavirin in other clinical trials; similar high SVR rates in patients with scores ≥5 were reported. CONCLUSIONS The scoring system can reliably identify treatment-naive HCV genotype 1 mono-infected Caucasian patients who have a high probability of achieving an SVR with peginterferon alfa-2a/ribavirin and will be particularly useful where protease inhibitors are not readily available.
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