Clinical Value of the Monocyte-to-Lymphocyte Ratio for Determining Number of Debridements in Treatment of Fournier’s Gangrene

Abstract

Aim: Fournier’s gangrene (FG) is a rapidly progressive, fulminant necrotizing fasciitis of the anogenital region. Treatment of FG consists of aggressive surgical debridements. The current scoring systems in FG focus on mortality. However, simple biomarkers could be useful. Here we aim to investigate the clinical usefulness of monocyte-to-lymphocyte ratio (MLR) in determining the number of debridements in FG patients. Method: Fifty-nine patients were diagnosed with FG and operated in the emergency unit between 2010 and 2016. The patients were separated into a single-debridement group and a multiple-debridement group. The groups were compared in terms of mean age, gender, duration of symptoms, predisposing factors, wound culture positivity, MLR values at admission, treatment protocols, and mortality rates. Results: The two groups differed significantly in wound culture results and colostomy status (p=0.001 and p=0.008). There was no significant difference in mortality rate (p=0.749). Furthermore, there were no significant differences between the groups in terms of predisposing factors or duration of symptoms (p=0.069 and p=0.091). The multiple-debridement group had a significantly higher MLR value (p<0.001). MLR under the cutoff value of 0.549 had 79.4% sensitivity and 76% specificity in the prediction of number of debridements. Furthermore, MLR value could predict the number of debridements independently from other factors (p<0.001). Conclusion: MLR value was significantly higher in patients who underwent multiple debridements. Thus, MLR shows promise as a single-parameter biomarker for FG severity. Future studies should focus on this parameter using a larger number of FG patients.

Keywords

• Fournier’s gangrene
• debridement
• monocyte
• lymphocyte