The effect of changes in mean platelet volume (MPV), red cell distrubution width (RDW), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) of fournier gangrenes prognosis

INTRODUCTION AND OBJECTIVE: In Fournier's Gangrene (FG), there is not a single scale which has been reached a consensus in the prediction of disease prognosis. This study aims to investigate whether the mean platelet volume (MPV), red cell width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are effective in predicting prognosis in patients with FG. MATERIALS AND METHODS: This retrospective study included the patients with FG, who were treated and followed at Sakarya University Training and Research Hospital, General Surgery Clinic, between January 2009 and January 2016. Hospital records, demographic data, presence of risk factors, clinical findings on admission, the width of the infected area, growing microorganisms in the wound culture, antibiotics used, length of hospitalization, laboratory findings (MPV, RDW, NLR, PLR), The Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI), number of surgical debridement, and intensive care followup parameters were evaluated in detail. In addition, MPV, RDW, NLR, and PLR values were determined separately during hospitalization, during treatment, and at the end of treatment. Altered levels of these parameters were analyzed and their predictive value for the course of the disease and prognosis were assessed. RESULTS: Of a total of 33 patients, 36.4% were females (n=12) and 63.6% were males (n=21). Treatment was successful in 72.7% of the patients (n=24), while it failed in 27.3% of them (n=9). The mortality rate was found to be statistically significantly higher in female patients who needed for intensive care during the postoperative period (p=0,001, p=0,044). In logistic regression analysis, FG-related mortality rate was found to be 9.310 times higher in women than in men. The NLR was found to be had tendency to increase at the beginning of treatment, during treatment, and at the end of the treatment in the patients who died despite treatment, whereas there was a statistically significant tendency to decrease in the patients who were treated successfully (p<0,05). In logistic regression analysis, the risk of mortality in the patients with a NLR value of >0.91 was observed to be increased by 40.583 times. The MPV was found to be not useful for the severity and extent of the disease or for other prognostic estimates on admission. However, the evaluation of the course of the MPV during the treatment can be helpful for making a prediction about the course of the disease. The tendency of MPV to decrease in the course of treatment may be an indicator of a better prognosis whereas the tendency of MPV to increase may be an indicator of a poor prognosis. There were differences only in the RDW results at the end of the treatment; the value at the final measurement was statistically significantly higher in the non-survivors, compared to the survivors (p=0.016). Despite statistically significant differences in PLR, these parameters cannot be decisive on the subject being investigated. CONCLUSION: Increased NLR appears to be an independent factor on mortality expectancy in FG. The course of MPV in disease progression and changes in RDW values are other parameters which can be useful in predicting prognosis in FG patients. However, further, multi-center, large-scale, prospective studies are required to establish a conclusion. Keywords: Fournier Gangrene, NLR, prognosis.