The Role of the Platelet Mass Index (PMI) as a New Prognostic Factor in Fournier's Gangrene

Introduction: Fournier's Gangrene is a mortal disease. Monitoring of the prognosis of patients is of utmost importance while planning the treatment strategies. Objectives: To evaluate the platelet mass index (PMI) calculated by multiplying the platelet count by the mean platelet volume, the Uludag Fournier's Gangrene Severity Index (UFGSI) and some biochemical markers including Mg, for predicting mortality in a single-center patient population with Fournier's Gangrene (FG). Subjects and methods: The medical records were reviewed for 46 patients with FG who were treated and followed up in a tertiary care center between May 2005 and November 2017. The medical history of the patients. physical examination findings, biochemical and hematological data. and bacteriological results were recorded. Antibiotic therapy and the extent of debridement were also recorded. The PM! level, Mg level, and UFGSI score were evaluated and stratified by survival. Results: The results were evaluated for the survivor (n = 33) and non-survivor (n =13) patients. The first symptom had appeared in the scrotum in 20 survivors and 10 non-survivors, in the perineum in 10 survivors and 2 non-survivors, in the penis in 1 survivor and in 2 nonsurvivors, and in the inguinal region in 3 survivors. The mean admission time was 7.12 days for survivors and 6.77 days for nonsurvivors. The mean wound surface area involved in the necrotizing process was 2.05% in survivors and 3.12% in nonsurvivors (P= 0.087).The PM! levels at admission were 2283.52 +/- 856.84 and 2085.73 +/- 1003.40, for the survivors and nonsurvivors, respectively (P=0.505), whereas the final PMI levels were 2930.08 +/- 877.01 and 1473.15 +/- 937.74, respectively (P <0.001). The admission UFGSI and ACCI scores were significantly higher in non-survivors (P =0.002. P=0.002, respectively). Hypomagnesemia, low albumin, high heart and respiratory rates, UFGSI > 9, and high ACCI were associated with worse prognosis. Categorical variables were compared using Pearson's Chi-square test. White independent samplet test or Mann-Whitney U test were used to compare continuous variables. Receiver operating characteristics (ROC) analysis revealed that the final PMI level was more powerful than the UFGSI and Mg level. Conclusion: Low PMI levels might be an important parameter for a worse FG prognosis. Monitoring the PMI levels might therefore have prognostic and therapeutic implications, as high UFGSI scores and low Mg levels could be associated with a worse prognosis in patients with FG. (C) 2018 Pan African Urological Surgeons Association. Production and hosting by Elsevier B.V.