Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score.
OBJECTIVE
To identify effective factors in the survival of patients with Fournier's gangrene and to determine the accuracy of the Fournier's gangrene severity index score.


METHODS
In our clinic, 25 patients with Fournier's gangrene were treated between 1995 and 2000. Data were collected about medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic therapy used.


RESULTS
The results were evaluated in two groups: those who died (n = 6) and those who survived (n = 19). No statistically significant difference was found between the age of the survivors and those who died. The admission and final laboratory parameters that correlated statistically significantly with outcome included urea, creatinine, bicarbonate, sodium, potassium, total protein, albumin, leukocyte count, hematocrit, lactate dehydrogenase, and alkaline phosphatase. The greater mean extent of body surface area involved among patients who died was significantly different statistically from that of those who survived (5.4% and 2.1%, P < or =0.0001). The mean Fournier's gangrene severity index score (FGSIS) for survivors was 3.0 +/- 1.8 compared with 12 +/- 2.4 for nonsurvivors. Regression analysis demonstrated a strong correlation between the Fournier's gangrene severity index score and the death rate (P < or =0.0001).


CONCLUSIONS
Patients' metabolic status and the extent of disease at presentation is an important factor in the prognosis of Fournier's gangrene. We suggest the clinical use of FGSIS, which is simple and objective when evaluating therapeutic options and predicting outcome.
Department of Urology, SSK Izmir Hospital, Izmir, Turkey.
Cem Ozden
CO
Yeniyol
Tufan
T
Suelozgen
Murat
M
Arslan
Ali Riza
AR
Ayder
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000900:Anti-Bacterial Agents; D001798:Blood Proteins / Q000032:analysis; D003131:Combined Modality Therapy; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003646:Debridement; D048909:Diabetes Complications / Q000453:epidemiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004573:Electrolytes / Q000097:blood; D005500:Follow-Up Studies; D018934:Fournier Gangrene / Q000097:blood / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality* / Q000601:surgery; D006400:Hematocrit; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
D000900:Anti-Bacterial Agents; D001798:Blood Proteins; D004573:Electrolytes; D014508:Urea; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D000469:Alkaline Phosphatase