National Study of Fournier Gangrene in Spain (2016–2021): Gender/Sex Differences in Mortality and Risks
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Data Source, and Study Period
2.2. Variables
2.3. Data Analysis
2.4. Ethical Aspects
3. Results
3.1. Yearly Evolution
3.2. Epidemiological Characteristics of Participants
3.3. Sex Differences in Participant Characteristics
3.4. Crude and Standarized Rate of Mortality
3.5. Sex Differences in Mortality
3.6. Risk Factors for Mortality among All Patients
3.7. Risk Factors for Mortality among Men and Women
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Transparency Statement
References
- Fournier, A. Gangéne foudroyante de la verge. Sem. Med. 1883, 3, 345–348. [Google Scholar]
- Desai, R.; Batura, D. A contemporaneous narrative review of Fournier’s gangrene. Urologia 2023, 90, 201–208. [Google Scholar] [CrossRef] [PubMed]
- 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. [Google Scholar] [CrossRef] [PubMed]
- Arora, A.; Rege, S.; Surpam, S.; Gothwal, K.; Narwade, A. Predicting Mortality in Fournier Gangrene and Validating the Fournier Gangrene Severity Index: Our Experience with 50 Patients in a Tertiary Care Center in India. Urol. Int. 2019, 102, 311–318. [Google Scholar] [CrossRef] [PubMed]
- Sorensen, M.D.; Krieger, J.N.; Rivara, F.P.; Broghammer, J.A.; Klein, M.B.; Mack, C.D.; Wessells, H. Fournier’s Gangrene: Population based epidemiology and outcomes. J. Urol. 2009, 181, 2120–2126. [Google Scholar] [CrossRef]
- Doluoğlu, Ö.G.; Karagöz, M.A.; Kılınç, M.F.; Karakan, T.; Yuceturk, C.N.; Sarici, H.; Ozgur, B.C.; Eroglu, M. Overview of different scoring systems in Fournier’s Gangrene and assessment of prognostic factors. Turk. J. Urol. 2016, 42, 190–196. [Google Scholar] [CrossRef]
- Wirjopranoto, S.; Affandi, M.R.; Ashari, F.Y.; Azmi, Y.A.; Soetanto, K.M. Evaluating prognostic indicators for in-hospital mortality in Fournier’s gangrene: A 7-year study in a tertiary hospital. Arch. Ital. Urol. Androl. 2024, 96, 12387. [Google Scholar] [CrossRef]
- Yilmazlar, T.; Ozturk, E.; Ozguc, H.; Ercan, I.; Vuruskan, H.; Oktay, B. Fournier’s gangrene: An analysis of 80 patients and a novel scoring system. Tech. Coloproctol. 2010, 14, 217–223. [Google Scholar] [CrossRef]
- Tosun, Y.; Akıncı, O.; Küçük, H.F. Risk factors for mortality in Fournier’s gangrene of anorectal origin. Ulus. Travma Acil Cerrahi Derg. 2022, 28, 1128–1133. [Google Scholar] [CrossRef]
- Ferretti, M.; Saji, A.A.; Phillips, J. Fournier’s Gangrene: A Review and Outcome Comparison from 2009 to 2016. Adv. Wound Care (New Rochelle) 2017, 6, 289–295. [Google Scholar] [CrossRef] [PubMed]
- Temoçin, F.; Atilla, A.; Kuruoğlu, T.; Kamalı-Polat, A. Fournier’s Gangrene: Microbiological Profile and Risk Factors for Mortality: Review of 97 Cases. Infect. Dis. Clin. Microbiol. 2023, 5, 13–22. [Google Scholar] [CrossRef] [PubMed]
- Real Decreto 69/2015, de 6 de febrero, por el que se regula el Registro de Actividad de Atención Sanitaria Especializada. Boletín Oficial del Estado, 1235: 10790-10890. Available online: https://www.sanidad.gob.es/estadEstudios/estadisticas/docs/BOE_RD_69_2015_RAE_CMBD.pdf (accessed on 3 August 2024).
- Montero-Vilchez, T.; Grau-Perez, M.; Garcia-Doval, I. Epidemiology and Geographic Distribution of Generalized Pustular Psoriasis in Spain: A National Population-Based Study of Hospital Admissions from 2016 to 2020. Actas Dermosifiliogr. 2023, 114, 97–101. [Google Scholar] [CrossRef] [PubMed]
- Ramos-Rincón, J.M.; Pinargote-Celorio, H.; González-de-la-Aleja, P.; Sánchez-Payá, J.; Reus, S.; Rodríguez-Díaz, J.-C.; Merino, E. Impact of influenza related hospitalization in Spain: Characteristics and risk factor of mortality during five influenza seasons (2016 to 2021). Front. Public Health 2024, 12, 1360372. [Google Scholar] [CrossRef] [PubMed]
- Bensardi, F.Z.; Hajri, A.; Kabura, S.; Bouali, M.; El Bakouri, A.; El Hattabi, K.; Fadil, A. Fournier’s gangrene: Seven years of experience in the emergencies service of visceral surgery at Ibn Rochd University Hospital Center. Ann. Med. Surg. (Lond.) 2021, 71, 102821. [Google Scholar] [CrossRef]
- Singh, A.; Ahmed, K.; Aydin, A.; Khan, M.S.; Dasgupta, P. Fournier’s gangrene. A clinical review. Arch. Ital. Urol. Androl. 2016, 88, 157–164. [Google Scholar] [CrossRef]
- Jiménez-Pacheco, A.; Arrabal-Polo, M.Á.; Arias-Santiago, S.; Arrabal-Martín, M.; Nogueras-Ocaña, M.; Zuluaga-Gómez, A. Fournier gangrene: Description of 37 cases and analysis of associated health care costs. Actas Dermosifiliogr. 2012, 103, 29–35. [Google Scholar] [CrossRef] [PubMed]
- Oyelowo, N.; Ahmed, M.; Lawal, A.T.; Sudi, A.; Tolani, A.M.M.A.; Fidelis, L.; Bello, A.; Maitama, H.Y. Fournier’s gangrene: Presentation and predictors of mortality in Zaria, Nigeria. Ann. Afr. Med. 2021, 20, 105–110. [Google Scholar] [CrossRef]
- Shet, P.; Mustafa, A.D.; Varshney, K.; Rao, L.; Sawdagar, S.; McLennan, F.; Ansari, S.; Shet, D.; Sivathamboo, N.; Campbell, S. Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review. Surg. Infect. 2024, 25, 261–271. [Google Scholar] [CrossRef]
- Koch, G.E.; Abbasi, B.; Agoubi, L.; Breyer, B.N.; Clark, N.; Dick, B.P.; Friedrich, J.B.; Hampson, L.A.; Hernandez, A.; Maine, R.; et al. Multidisciplinary management in Fournier’s gangrene. Curr. Probl. Surg. 2024, 61, 101499. [Google Scholar] [CrossRef]
- Khalid, A.; Devakumar, S.; Huespe, I.; Kashyap, R.; Chisti, I. A Comprehensive Literature Review of Fournier’s Gangrene in Females. Cureus 2023, 15, e38953. [Google Scholar] [CrossRef]
- Furr, J.; Watts, T.; Street, R.; Cross, B.; Slobodov, G.; Patel, S. Contemporary trends in the inpatient management of Fournier’s gangrene: Predictors of length of stay and mortality based on population-based sample. Urology 2017, 102, 79–84. [Google Scholar] [CrossRef]
- Kim, S.Y.; Dupree, J.M.; Le, B.V.; Kim, D.Y.; Zhao, L.C.; Kundu, S.D. A contemporary analysis of Fournier gangrene using the National Surgical Quality Improvement Program. Urology 2015, 85, 1052–1057. [Google Scholar] [CrossRef] [PubMed]
- Tenório, C.E.L.; Lima, S.V.C.; Albuquerque, A.V.; Cavalcanti, M.P.; Teles, F. Risk factors for mortality in fournier’s gangrene in a general hospital: Use of simplified founier gangrene severe index score (SFGSI). Int. Braz. J. Urol. 2018, 44, 95–101. [Google Scholar] [CrossRef] [PubMed]
- Lin, T.Y.; Ou, C.H.; Tzai, T.S.; Tong, Y.; Chang, C.; Cheng, H.; Yang, W.; Lin, Y. Validation and simplification of Fournier’s Gangrene Severity Index. Int. J. Urol. 2014, 21, 696–701. [Google Scholar] [CrossRef] [PubMed]
- Tufano, A.; Dipinto, P.; Passaro, F.; Anceschi, U.; Franco, G.; Flammia, R.S.; Proietti, F.; Antonelli, L.; Di Pierro, G.B.; Prata, F.; et al. The Value of Fournier’s Gangrene Scoring Systems on Admission to Predict Mortality: A Systematic Review and Meta-Analysis. J. Pers. Med. 2023, 13, 1283. [Google Scholar] [CrossRef] [PubMed]
- El-Qushayri, A.E.; Khalaf, K.M.; Dahy, A.; Mahmoud, A.R.; Benmelouka, A.Y.; Ghozy, S.; Mahmoud, M.U.; Bin-Jumah, M.; Alkahtani, S.; Abdel-Daim, M.M. Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis. Int. J. Infect. Dis. 2020, 92, 218–225. [Google Scholar] [CrossRef] [PubMed]
- Simsek, A. Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier’s Gangrene Leading to Mortality and Irreversible Organ Damage. Wounds 2022, 34, 31–35. [Google Scholar] [CrossRef]
- Zhang, K.F.; Shi, C.X.; Chen, S.Y.; Wei, W. Progress in Multidisciplinary Treatment of Fournier’s Gangrene. Infect. Drug Resist. 2022, 15, 6869–6880. [Google Scholar] [CrossRef]
- Bozkurt, F.T.; Öncel, H.F.; Salar, R. Predictive factors for mortality in intensive care patients with Fournier’s gangrene: Five years’ experience from a single center in Turkey. Eur. Rev. Med. Pharmacol. Sci. 2023, 27, 2326–2331. [Google Scholar] [CrossRef]
- Rello, J.; Valenzuela-Sánchez, F.; Ruiz-Rodriguez, M.; Moyano, S. Sepsis: A review of advances in management. Adv. Ther. 2017, 34, 2393–2411. [Google Scholar] [CrossRef] [PubMed]
ICD-10 Codes | |
---|---|
Diseases | |
Fournier Gangrene for men | N49.3 |
Fournier gangrene in women (other specified inflammation of vagina and vulva) | N76.89 |
Comorbidities | |
Hypertension | I10; I11; I12; I13; I15 |
Diabetes mellitus | E10; E11 |
Dyslipidemia | E78 |
Smoking | F17 |
Neoplasms | C01; C02; C03; C04; C05; C06; C07; C08; C09; C10; C11; C12; C13; C14; C15; C16; C17; C18; C19; C20; C21; C22; C23; C24; C25; C26; C27; C28; C29; C30; C31; C32; C33; C34; C35; C36; C37; C38; C39; C40; C41; C42; C43; C44; C45; C46; C47; C48; C49; C50; C51; C52; C53; C54; C55; C56; C57; C58; C59; C60; C61; C62; C63; C64; C65; C66; C67; C68; C69; C70; C71; C72; C73; C74; C75; C76; C77; C78; C79; C80 |
Obesity | E66 |
Chronic kidney disease | N18 |
Alcohol consumption | F10 |
Ischemic heart disease | I21; I22; I23; I24; I25 |
COPD | J44 |
Heart failure | I50 |
Leukemia | C92; C93; C94; C95; C96 |
Lymphoma | C81; C82; C83; C84; C85; C86; C87; C88; C89; C90; C91 |
Cirrhosis | K74 |
Vascular disease | I73 |
Hepatitis C | B18.2; B19.20; B19.21 |
HIV | B20 |
Transplant | Z94 |
Complications | |
Sepsis | A40; A41 |
Acute kidney injury | N17 |
Pulmonary embolism | I26 |
Microbiology | |
Escherichia coli | B96.2 |
Streptococcus | B95.0; B95.1; B95.4; B95.5 |
Staphylococcus | B96.6; B95.7; B95.8 |
Pseudomonas | B96.5 |
Men | Women | Total | |||||||
---|---|---|---|---|---|---|---|---|---|
N | RH a | RH b | N | RH a | RH b | N | RH a | RH b | |
Crude Rates | |||||||||
2016 | 366 | 0.17 | 1.6 | 91 | 0.04 | 0.4 | 457 | 0.10 | 1.0 |
2017 | 386 | 0.18 | 1.7 | 91 | 0.04 | 0.4 | 477 | 0.10 | 1.0 |
2018 | 510 | 0.23 | 2.2 | 121 | 0.05 | 0–5 | 631 | 0.14 | 1.4 |
2019 | 492 | 0.22 | 2.1 | 101 | 0.04 | 0.4 | 593 | 0.13 | 1.3 |
2020 | 581 | 0.30 | 2.5 | 124 | 0.06 | 0.5 | 705 | 0.17 | 1.5 |
2021 | 670 | 0–32 | 2.9 | 111 | 0.05 | 0.5 | 781 | 0.18 | 1.6 |
Mean | 490 | 0.23 | 2.7 | 106 | 0.05 | 0.4 | 596 | 0.14 | 1.7 |
Standarized rates * | |||||||||
2016 | - | 0.182 | 1.7 | - | 0.042 | 0.4 | - | 0.107 | 1.0 |
2017 | - | 0.186 | 1.8 | - | 0.039 | 0.4 | - | 0.108 | 1.0 |
2018 | - | 0.239 | 2.4 | - | 0.049 | 0.5 | - | 0.138 | 1.4 |
2019 | - | 0.231 | 2.3 | - | 0.041 | 0.4 | - | 0.131 | 1.3 |
2020 | - | 0.319 | 2.6 | - | 0.061 | 0.5 | - | 0.182 | 1.5 |
2021 | - | 0.330 | 3.0 | - | 0.047 | 0.4 | - | 0.181 | 1.6 |
Mean | - | 0.24 | 3.0 | - | 0.05 | 0.4 | - | 0.14 | 1.3 |
Total a | Men a | Women a | p Value b | |
---|---|---|---|---|
Total | 3641 (100) | 3004 (82.5) | 637 (17.5) | — |
Age (years) | ||||
median (IQR) | 63(49–76) | 63 (55–73) | 62 (49–76) | 0.059 |
<64 y | 1950 (53.5) | 1605 (53.4) | 345 (51.0) | <0.001 |
65–70 y | 1179 (22.4) | 1007 (33.5) | 173 (26.9) | |
≥80 y | 515 (14.1) | 293 (13.1) | 122 (19.7) | |
Primary diagnosis | 3114 (85.5) | 2618 (87.1) | 496 (77.5) | <0.001 |
Comorbidities | ||||
Hypertension | 1637 (44.9) | 1371 (45.6) | 266 (41.6) | 0.066 |
Diabetes mellitus | 1288 (35.3) | 1060 (35.3) | 228 (35.7) | 0.845 |
Dyslipidemia | 921 (25.3) | 761 (25.3) | 160 (25.0) | 0.920 |
Smoking | 666 (18.3) | 602 (20.0) | 63 (10.0) | <0.001 |
Obesity | 520 (14.3) | 385 (12.8) | 135 (21.1) | <0.001 |
Neoplasms | 458 (12.6) | 392 (13.0) | 66 (10.3) | 0.066 |
Alcohol consumption | 344 (9.4) | 335 (11.1) | 9 (1.4) | <0.001 |
Chronic kidney disease | 306 (8.4) | 239 (7.9) | 68 (10.6) | 0.028 |
COPD | 262 (7.2) | 252 (8.4) | 10 (1.6) | <0.001 |
Heart failure | 258 (7.1) | 195 (6.5) | 63 (9.9) | 0.003 |
Ischemic heart disease | 229 (6.3) | 206 (6.9) | 23 (3.6) | 0.003 |
Hepatitis C | 55 (1.5) | 50 (1.7) | 5 (0.8) | 0.109 |
Cirrhosis | 37 (1.0) | 36 (1.29 | 1 (0.2) | 0.014 |
Lymphoma | 35 (1.0) | 24 (0.9) | 11 (1.7) | 0.042 |
Leukemia | 27 (0.7) | 20 (0.7) | 7 (1.1) | 0.250 |
Vascular disease | ||||
Transplant | 26 (0.7) | 24 (0.8) | 2 (0.39 | 0.185 |
HIV | 18 (0.5) | 15 (0.5) | 3 (0.5) | 1.00 |
Complications | ||||
Sepsis | 828 (22.7) | 669 (23.3) | 159 (24.9) | 0.151 |
Acute kidney injury | 627 (17.2) | 16.9 (50) | 120 (18.8) | 0.249 |
Pulmonary embolism | 29 (0.9) | 23 (0.8) | 6 (0.9) | 0.625 |
ICU admission | 189 (29.8) | 1119 (31.1) | 930 (31.4) | 0.436 |
Days in ICU, median (IQR) | 5 (2–11) | 4 (2–11) | 6 (2–13) | 0.140 |
Hospital mortality | 588 (20.9) | 455 (15.1) | 133 (20.9) | 0.002 |
Days in hospital, median (IQR) | 18 (8–33) | 18 (9–33) | 16 (6–32) | 0.002 |
Surgical intervention | ||||
<48 h after intervention | 2918 (80.1) | 2398 (79.8) | 520 (81.4) | 0.365 |
Microbiology (ICD-10 code) | ||||
Escherichia coli | 519 (14.2) | 427 (14.29 | 92 (14.4) | 0.902 |
Streptococcus | 269 (7.4) | 223 (7.4) | 46 (7.29 | 0.845 |
Staphylococcus | 190 (5.2) | 166 (5.5) | 24 (3.9) | 0.068 |
Pseudomonas | 163 (4.5) | 140 (4.7) | 23 (3.6) | 0.239 |
Men | Women | Total | |||||||
---|---|---|---|---|---|---|---|---|---|
N | RH a | RH b | N | RH a | RH b | N | RH a | RH b | |
Crude rates | |||||||||
2016 | 67 | 0.22 | 0.29 | 19 | 0.08 | 0.08 | 86 | 0.15 | 0.18 |
2017 | 67 | 0.31 | 0.29 | 15 | 0.07 | 0.06 | 82 | 0.19 | 0.18 |
2018 | 65 | 0.30 | 0.28 | 25 | 0.19 | 0.10 | 90 | 0.21 | 0.19 |
2019 | 66 | 0.31 | 0.28 | 23 | 0.11 | 0.10 | 89 | 0.21 | 0.19 |
2020 | 87 | 0.35 | 0.37 | 25 | 0.10 | 0.10 | 112 | 0.23 | 0.23 |
2021 | 103 | 0.44 | 0.44 | 26 | 0.12 | 0.10 | 129 | 0.29 | 0.27 |
Mean | 75 | 0.31 | 0.33 | 22 | 0.010 | 0.09 | 97 | 0.21 | 0.21 |
Standardized rates * | |||||||||
2016 | - | 0.4 | 0.33 | 0.33 | 0.08 | 0.43 | 0.19 | ||
2017 | - | 0.50 | 0.32 | 0.14 | 0.05 | 0.38 | 0.17 | ||
2018 | - | 0.41 | 0.31 | 0.24 | 0.09 | 0.35 | 0.19 | ||
2019 | - | 0.38 | 0.31 | 0.17 | 0.08 | 0.31 | 0.18 | ||
2020 | - | 0.63 | 0.40 | 0.48 | 0.10 | 0.58 | 0.24 | ||
2021 | - | 0.58 | 0.48 | 0.23 | 0.09 | 0.46 | 0.27 | ||
Mean | - | 0.50 | 0.36 | 0.27 | 0.08 | 0.42 | 0. 21 |
HM in men, % (n/N) a | HM in women, % (n/N) a | OR (95% CI) | p Value b | |
---|---|---|---|---|
Total | 15.1 (455/3004) | 20.9 (133/637) | 1.48 (1.19–1.83) | 0.001 |
Age in years | ||||
<64 y | 7.9 (127/1605) | 10.2 (35/344) | 0.98 (0.69–1.38) | 0.163 |
65–80 y | 20.0 (201/1006) | 28.7 (49/171) | 1.44 (1.03–1.96) | 0.015 |
≥80 y | 32.3 (127/393) | 40.2 (49/122) | 1.29 (0.94–1.78) | 0.126 |
Hypertension | ||||
No | 13.3 (218/1634) | 14.5 (54/372) | 1.03 (0.80–1.52) | 0.557 |
Yes | 17.3 (237/1370) | 29.8 (79/265) | 2.03 (1.50–2.73) | <0.001 |
Diabetes | ||||
No | 16.2 (315/1944) | 18.2 (75/411) | 1.15 (0.87–1.52) | 0.311 |
Yes | 13.2 (150/1060) | 25.5 (58/226) | 2.27 (1.60–3.21) | <0.001 |
Dyslipidemia | ||||
No | 15.1 (338/2244) | 20.5 (98/477) | 1.45 (1.13–1.87) | 0.003 |
Yes | 15.4 (117/760) | 21.9 (35/160) | 1.53 (1.00–2.15) | 0.060 |
Smoking | ||||
No | 16.1 (387/2402) | 21.6 (124/573) | 1.14 (1.43–1.80) | 0.002 |
Yes | 11.3 (68/602) | 14.1 (9/64) | 1.28 (0.60–2.71) | 0.532 |
Neoplasms | ||||
No | 12.8 (335/2612) | 20.0 (114/571) | 1.69 (1.34–2.14) | <0.001 |
Yes | 30.6 (120/392) | 28.8 (19/66) | 0.91 (0.51–1.62) | 0.885 |
Obesity | ||||
No | 15.3 (401/2620) | 20.7 (104/503) | 1.44 (1.13–1.83) | 0.003 |
Yes | 14.1 (54/384) | 21.6 (29/134) | 1.68 (1.02–2.78 | 0.055 |
Chronic kidney disease | ||||
No | 13.7 (378/2766) | 18.1 (103/569) | 1.39 (1.09–177) | 0.006 |
Yes | 32.4 (77/238) | 44.1 (30/68) | 1.65 (0.95–2.86) | 0.084 |
Alcohol consumption | ||||
No | 14.9 (398/2669) | 20.9 (131/628) | 1.50 (1.21–1.87) | <0.001 |
Yes | 17.0 (57/335) | 22.2 (2/9) | 1.39 (0.28–6.88) | 0.656 |
Ischemic heart disease | ||||
No | 14.8 (413/2798) | 20.5 (126/614) | 1.49 (1.19–1.86) | <0.001 |
Yes | 20.4 (42/206) | 30.4 (7/23) | 1.71 (0.66–4.42) | 0.286 |
COPD | ||||
No | 14.3 (394/2752) | 20.7 (130/627) | 1.56 (1.26–1.95) | <0.001 |
Yes | 24.2 (61/252) | 30.0 (3/10) | 1.34 (0.33–5.34) | 0.710 |
Heart failure | ||||
No | 13.4 (377/2810) | 19.2 (110/574) | 1.53 (1.21–1.93) | <0.001 |
Yes | 40.2 (78/194) | 36.5 (23/63) | 0.85 (0.76–1.53) | 0.603 |
Leukemia | ||||
No | 15.0 (449/2984) | 20.5 (129/630) | 1.45 (1.17–1.80) | <0.001 |
Yes | 30.0 (6/20) | 57.1 (4/7) | 3.11 (0.52–18.3) | 0.376 |
Lymphoma | ||||
No | 15.0 (448/2980) | 20.8 (130/626) | 1.48 (1.19–1.84) | <0.001 |
Yes | 29.2 (7/24) | 27.3 (3/11) | 0.91 (1.18–4.47) | 1.00 |
Cirrhosis | ||||
No | 15.0 (446/2968) | 20.9 (579/3604) | 1.49 (1.20–1.85) | <0.001 |
Yes | 25.0 (9/36) | 0.0 (0/1) | NA | 1.00 |
Hepatitis C | ||||
No | 15.0 (443/2954) | 20.9 (132/632) | 1.49 (1.20–1.85) | <0.001 |
Yes | 24.4 (12/50) | 20.0(1/5) | 0.79 (0.08–7.78) | 1.00 |
HIV | ||||
No | 15.2 (454/2989) | 20.7 (131/634) | 1.45 (1.17–1.80) | 0.001 |
Yes | 6.7 (1/15) | 66.7 (2/3) | 28.0 (1.2–648) | 0.056 |
Transplant | ||||
No | 15.0 (448/2980) | 20.9 (133/635) | 1.49 (1.20–1.83) | <0.001 |
Yes | 29.2 (7/24) | 29.2 (0/2) | NA | 1.00 |
Sepsis | ||||
No | 9.2 (214/2236) | 13.4 (64/479) | 1.53 (1.13–2.06) | 0.005 |
Yes | 36.1 (241/668) | 43.7 (69/158) | 1.37 (0.96–1.95) | 0.083 |
Acute kidney injury | ||||
No | 9.9 (248/2497) | 13.7 (71/518) | 1.44 (1.08–1.91) | 0.011 |
Yes | 40.8 (207/507) | 52.1 (62/119) | 1.56 (1.05–2.35) | 0.035 |
Pulmonary embolism | ||||
No | 15.9 (447/2981) | 20.8 (131/631) | 1.48 (1.19–1.84) | <0.001 |
Yes | 34.8 (8/23) | 33.3 (2/6) | 0.93 (0.14–6.28) | 1.00 |
ICU admission | ||||
No | 10.1 (205/2033) | 15.1 (67/445) | 1.58 (1.17–2.18) | 0.002 |
Yes | 26.4 (245/929) | 34.8 (65/187) | 1.48 (1.06–2.07) | 0.025 |
All Patients | Men | Female | ||||
---|---|---|---|---|---|---|
Hospital Mortality, % (n/N) a | p Value b | Hospital mortality, % (n/N) a | p Value b | Hospital mortality, % (n/N) a | p Value b | |
Total | 16.1 (588/3641) | — | 15.1 (445/3004) | — | 20.9 (133/558) | — |
Sex | ||||||
Male | 15.1 (445/3004) | — | — | — | — | |
Female | 20.9 (133/558) | <0.001 | — | — | — | — |
Age | ||||||
< 64 y | 8.3 (162(1949) | — | 7.9 (127/1605) | — | 10.2 (35/344) | — |
65–70 y | 21.2 (250/1177) | <0.001 | 20.0 (201/1006) | <0.001 | 28.7 (49/171) | <0.001 |
≥ 80 y | 34.0 (176/517) | <0.001 | 32.3 (127/393) | <0.001 | 40.2 (49/122) | <0.001 |
Hypertension | ||||||
No | 13.6 (272/2006) | — | 13.3 (218/634) | — | 14.5 (54/372) | — |
Yes | 19.3 (316/163) | <0.001 | 17.3 (237–1370) | 0.003 | 29.8 (79/265) | <0.001 |
Diabetes | ||||||
No | 16.6 (390/2355) | — | 16.2 (315/1944) | — | 18.2 (75/411) | — |
Yes | 15.4 (198/1288) | 0.371 | 13.2 (140/1060) | 0.029 | 25.7 (58/226) | 0.032 |
Dyslipidemia | ||||||
No | 16.0 (436/2722) | — | 15.1 (338/2244) | — | 20.5 (98/477) | — |
Yes | 16.5 (152/921) | 0.717 | 15.4 (117/760) | 0.398 | 21.9 (35/160) | 0.720 |
Smoking | ||||||
No | 17.2 (511/2977) | — | 16.1 (387/2402) | — | 21.0 (124/573) | — |
Yes | 11.6 (77/666) | <0.001 | 11.3 (68/602) | 0.003 | 14.1 (9/64) | 0.195 |
Neoplasms | ||||||
No | 14.1 (449/3185) | — | 12.8 (335/2612) | — | 20.0 (114/571) | — |
Yes | 30.3 (139/458) | <0.001 | 30.6 (120/392) | <0.001 | 28.8 (19/66) | 0.916 |
Obesity | ||||||
No | 16.2 (505/3124) | — | 15.3 (401/2620) | — | 20.7 (104/503) | — |
Yes | 16.0 (83/519) | 0.946 | 14.1 (54/384) | 0.593 | 21.6 (29/134) | 0.811 |
Chronic kidney disease | ||||||
No | 14.4 (481/335) | — | 13.7 (378/2766) | — | 18.1 (103/569) | — |
Yes | 34.7 (107/308) | <0.001 | 32.4 (77/238) | <0.001 | 44.1 (30/68) | <0.001 |
Alcohol consumption | ||||||
No | 16.0 (529/3299) | — | 14.9 (398/2669) | — | 20.9 (131/628) | — |
Yes | 17.2 (59/344) | 0.592 | 17.5 (57/335) | 0.332 | 22.2 (2/9) | 0.988 |
Ischemic heart disease | ||||||
No | 15.8 (539/3414) | — | 14.8 (413/2798) | — | 20.8 (126/614) | — |
Yes | 21.4 (49/229) | 0.032 | 20.4 (42/206) | 0.034 | 30.4 (7/23) | 0.293 |
COPD | ||||||
No | 15.5 (524/3381) | 14.3 (394/2752) | — | 20.7 (130/627) | — | |
Yes | 24.4 (64/262) | <0.001 | 24.2 (61/252) | <0.001 | 30.0 (3/10) | 0.443 |
Heart failure | ||||||
No | 14.4 (487/3386) | — | 13.4 (377/2810) | — | 19.2 (110/574) | — |
Yes | 39.3 (101/257) | <0.001 | 40.2 (78/194) | <0.001 | 26.5 (23/63) | 0.003 |
Leukemia | ||||||
No | 16.0 (578/3616) | — | 15.0 (449/2984) | — | 20.5 (129/630) | — |
Yes | 37.0 (10/17) | 0.007 | 30.0 (6/20) | 0.106 | 57.1 (4/7) | 0.038 |
Lymphoma | ||||||
No | 16.0 (578/3608) | — | 15.0 (4482980) | — | 20.3 (130/627) | — |
Yes | 28.6 (10/35) | 0.061 | 29.2 (7/24) | 0.078 | 27.3 (3711) | 0.706 |
Cirrhosis | ||||||
No | 16.1 (579/2606) | — | 15.0 (446/2968) | — | 20.9 (133/636) | — |
Yes | 24.3 (9/37) | 0.17 | 25.0 (9/36) | 0.102 | 0.0 (0/11) | 1.00 |
Hepatitis C | ||||||
No | 16.0 (575/3588) | — | 15.3 (443/2954) | — | 20.9 (132/632) | — |
Yes | 23.6 (13/55) | 0.138 | 24.0 (12/60) | 0.531 | 20.0 (1/5) | 1.00 |
HIV | ||||||
No | 16.1 (585/3625) | — | 15.2 (454/2989) | — | 20.7 (131/634) | — |
Yes | 16.7 (3/18) | 1.00 | 6.7 (1/15) | 0.213 | 66.7 (273) | 0.112 |
Transplant | ||||||
No | 16.1 (581/3617) | — | 15.0 (448/2980) | — | 20.9 (133/635 | — |
Yes | 26.9 (7/26) | 0.174 | 29.2 (7/24) | 0.078 | 0.0 (0/2) | 1.00 |
Sepsis | ||||||
No | 9.9 (278/2817) | — | 9.2 (214/2336) | — | 13.4 (64/479) | — |
Yes | 37.5 (310/826) | <0.001 | 36.1 (241/668) | <0.001 | 43.7 (69/479) | <0.001 |
Acute kidney injury | ||||||
No | 10.6 (319/3017) | — | 9.9 (248/2497) | — | 13.7 (71/518) | — |
Yes | 43.0 (269/626) | <0.001 | 40.8 (207/507) | <0.001 | 52.1 (62/119) | <0.001 |
Pulmonary embolism | ||||||
No | 16.0 (578/3614) | — | 15.0 (447/2981) | — | 20.8 (131/631) | — |
Yes | 34.5 (10/29) | 0.018 | 34.8 (8/23) | 0.016 | 33.3 (2/6) | 0.610 |
ICU admission | ||||||
No | 10.7 (272/2480) | — | 10.1 (205/2033) | — | 15.3 (67/445) | — |
Yes | 27.8 (310/1160) | <0.001 | 26.4 (245/929) | <0.001 | 34.8 (65/187) | <0.001 |
All Patients | Men | Female | ||||
---|---|---|---|---|---|---|
OR (95% CI) | p Value a | OR (95% CI) | p Value a | OR (95% CI) | p Value a | |
Total | — | — | — | — | — | — |
Sex | ||||||
Male | 1 | — | — | — | — | |
Female | 1.48 (1.19–1.83) | <0.001 | — | — | — | — |
Age | ||||||
<64 y | 1 | — | 1 | — | 1 | — |
65–70 y | 2.98 (2.40–3.68) | <0.001 | 2.90 (2.30–3.70) | <0.001 | 3.54 (2.19–5.74) | <0.001 |
≥80 y | 5.69 (4.40–7.35) | <0.001 | 5.55 (4.20–7.34) | <0.001 | 5.92 (3.8–9.80) | <0.001 |
Hypertension | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.55 (1.27–1.82) | <0.001 | 1.35 (1.11–1.65) | 0.003 | 2.50 (1.69–3.62) | <0.001 |
Diabetes | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 0.91 (0.76–1.10) | 0.371 | 0.78 (0.63–0.97) | 0.029 | 1.54 (1.05–2.29) | 0.032 |
Dyslipidemia | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.03 (0.84–1.26) | 0.717 | 1.02 (0.82–1.29) | 0.398 | 1.08 (0.70–1.64) | 0.720 |
Smoking | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 0.63 (0.49–0.81) | <0.001 | 0.66 (0.50–0.87) | 0.003 | 0.59 (0.28–1.23) | 0.195 |
Neoplasms | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 2.65 (2.12–3.21) | <0.001 | 2.99 (2.35–3.82) | <0.001 | 1.62 (0.91–2.86) | 0.916 |
Obesity | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 0.98 (0.76–1.27) | 0.946 | 0.90 (0.67–1.23) | 0.593 | 1.06 (0.66–168) | 0.811 |
Chronic kidney disease | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 3.16 (2.45–4.07) | <0.001 | 3.02 (2.25–4.05) | <0.001 | 3.57 (2.11–6.03) | <0.001 |
Alcohol consumption | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.08 (0.80–1.45) | 0.592 | 1.17 (0.86–1.58) | 0.332 | 1.84 (0.22–5.28) | 0.988 |
Ischemic heart disease | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.45 (1.04–2.02) | 0.032 | 1.49 (1.03–2.11) | 0.034 | 1.69 (0.68–4.20) | 0.293 |
COPD | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.76 (1.31–2.37) | <0.001 | 1.91 (1.40–2.60) | <0.001 | 1.63 (0.42–642) | 0.443 |
Heart failure | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 3.85 (2.94–5.04) | <0.001 | 4.33 (3.19–5.89) | <0.001 | 2.42 (1.39–4.21) | 0.003 |
Leukemia | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 3.09 (1.41–6.78) | 0.007 | 2.40 (0.92–6.33) | 0.106 | 5.18 (1.14–22.42) | 0.038 |
Lymphoma | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 2.09 (1.00–4.38) | 0.061 | 2.32 (0.96–5.64) | 0.078 | 1.43 (0.37–5.49) | 0.706 |
Cirrhosis | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.68 (0.78–3.58) | 0.17 | 1.88 (0.88–4.03) | 0.102 | NC | 1.00 |
Hepatitis C | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.63 (0.86–3.04) | 0.138 | 1.79 (0.93–3.45) | 0.531 | 0.42 (0.10–8.54 | 1.00 |
HIV | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.03 (0.30–3.61) | 1.00 | 0.39 (0.05–3.04) | 0.213 | 7.69 (0.69–85.23) | 0.112 |
Transplant | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 1.92 (0.80–4.60) | 0.174 | 2.32 (0.96–0.56) | 0.078 | NA | 1.00 |
Sepsis | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 5.48 (4.54–6.61) | <0.001 | 5.59 (4.53–6.91) | <0.001 | 6.02 (3.32–7.52) | <0.001 |
Acute kidney injury | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 6.37 (5.23–7.55) | <0.001 | 6.25 (5.03–7.80) | <0.001 | 6.84 (4.41–10.71) | <0.001 |
Pulmonary embolism | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 2.76 (1.28–5.97) | 0.018 | 3.02 (1.27–7.11) | 0.016 | 1.98 (0.34–10.53) | 0.610 |
ICU admission | ||||||
No | 1 | — | 1 | — | 1 | — |
Yes | 3.12 (2.63–3.74) | <0.001 | 3.19 (2.60–3.92) | <0.001 | 3.00 (2.02–4.47) | <0.001 |
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© 2024 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Belinchón-Romer, I.; Ramos-Belinchón, A.; Lobato-Martínez, E.; Sánchez-García, V.; Ramos-Rincón, J.-M. National Study of Fournier Gangrene in Spain (2016–2021): Gender/Sex Differences in Mortality and Risks. Medicina 2024, 60, 1600. https://doi.org/10.3390/medicina60101600
Belinchón-Romer I, Ramos-Belinchón A, Lobato-Martínez E, Sánchez-García V, Ramos-Rincón J-M. National Study of Fournier Gangrene in Spain (2016–2021): Gender/Sex Differences in Mortality and Risks. Medicina. 2024; 60(10):1600. https://doi.org/10.3390/medicina60101600
Chicago/Turabian StyleBelinchón-Romer, Isabel, Alberto Ramos-Belinchón, Ester Lobato-Martínez, Verónica Sánchez-García, and José-Manuel Ramos-Rincón. 2024. "National Study of Fournier Gangrene in Spain (2016–2021): Gender/Sex Differences in Mortality and Risks" Medicina 60, no. 10: 1600. https://doi.org/10.3390/medicina60101600