Fournier's gangrene: overview of prognostic factors and definition of new prognostic parameter.
OBJECTIVE
To identify the prognostic factors and the new parameters that might predict a worse outcome in nonsurvivors compared with survivors of Fournier's gangrene (FG) and evaluated the validity of the Fournier's Gangrene Severity Index (FGSI) in patients with FG.


METHODS
The medical records of 18 patients with FG who were treated and followed up in our clinic were reviewed. Data were collected in terms of medical history, symptoms, and physical examination findings. The biochemical, hematologic, and bacteriologic study (aerobic and anaeorobic wound cultures) results at admission and at the final evaluation, the physical examination findings, the timing and extent of surgical debridement, and the antibiotic therapy were also recorded. The Charlson Comorbidity Index (CCI) and FGSI were evaluated stratified by survival.


RESULTS
The results were evaluated for 2 groups: those who survived (n = 14) and those who did not (n = 4). The admission FGSI score was 5.00 +/- 2.91 (range 0-10) for survivors compared with 13.5 +/- 2.62 (range 9-15) for nonsurvivors (P = .001). The CCI score was 3 +/- 1.5 in survivors and 7 +/- 2.2 in nonsurvivors (P = .008). Individual laboratory parameters such as hypomagnesemia, hemoglobin, hematocrit, alkaline phosphatase, creatinine, and the heart and respiratory rates were associated with a worse prognosis. In addition, a FGSI >9, rectal involvement, colostomy diversion, and a high CCI were associated with high mortality.


CONCLUSIONS
Low magnesium levels might be a new parameter for a worse prognosis. High CCI and FGSI scores might be associated with a worse prognosis in patients with FG. A FGSI threshold of 9 was a predictor of mortality during the initial assessment.
Erol
Bulent
B
Department of Urology, Zonguldak Karaelmas University Faculty of Medicine, Zonguldak, Turkey. erolbulent@yahoo.com
Tuncel
Altug
A
Hanci
Volkan
V
Tokgoz
Husnu
H
Yildiz
Abdulkadir
A
Akduman
Bulent
B
Kargi
Eksal
E
Mungan
Aydin
A
D018934:Fournier Gangrene / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate