Is Fournier's gangrene severity index useful for predicting outcome of Fournier's gangrene?
OBJECTIVE
Fournier's gangrene (FG) is a rare but life-threatening disease. Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the mortality rate remains high. We conducted a retrospective study to analyze the outcome and identify the risk factors and prognostic indicators.


METHODS
We retrospectively reviewed the medical records of 25 patients diagnosed with FG between July 1993 and August 2003. Data collected included age, predisposing factors, treatment modalities, length of hospital stay, surgical debridement times, and outcome. The FG severity index was used to predict outcome. Univariate analysis of the different prognostic factors was performed using t test and Fisher's exact probability test.


RESULTS
All patients were male, 60% were diabetic, and the mean age was 55.8 years. The mean hospital stay was 20 days and the mortality rate was 32%. The mean age of 53.8+/-18.3 (SD) years in the survival group (n=17) was significantly lower than the 59.9+/-10.2 years (n=8) of the non-survival group (p<0.05). Non-survival group patients had lower serum hematocrit (mean 28.9, p=0.019) and albumin (mean 1.93, p=0.024) levels. In our series, the mean FG severity index for survivors was 4.41+/-2.45 (range 2-9) compared to 12.75+/-2.82 (range 9-18) for those who died (t test, p<0.0001).


CONCLUSIONS
The survival rate of younger patients with FG was higher. We agree that a FG severity index cutoff value of 9 is an excellent predictor of outcome.
Lin
Eugene
E
Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan.
Yang
Stone
S
Chiu
Allen W
AW
Chow
Yung-Chiong
YC
Chen
Marcelo
M
Lin
Wen-Chou
WC
Chang
Hung-Kuang
HK
Hsu
Jong-Ming
JM
Lo
King-Yik
KY
Hsu
Hsi-Hsien
HH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002423:Cause of Death; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents