title: Analysis of prognostic factors affecting mortality in Fournier's gangrene: A study of 72 cases.
abstract: BACKGROUND
  Fournier's gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality.
  
  
  METHODS
  We carried out a retrospective study of 72 patients treated for Fournier's gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and non-survivors and potential prognostic factors were analyzed.
  
  
  RESULTS
  Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier's Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002).
  
  
  CONCLUSIONS
  Fournier's gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tarchouli
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bounaim
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Mohamed
authors.initials: M
authors.lastname: Essarghini
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Moulay Brahim
authors.initials: MB
authors.lastname: Ratbi
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Mohamed Said
authors.initials: MS
authors.lastname: Belhamidi
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Abdelhak
authors.initials: A
authors.lastname: Bensal
authors.affiliation: Department of Anesthesiology and Intensive Care, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
authors.forename: Adil
authors.initials: A
authors.lastname: Zemmouri
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Abdelmounaim Ait
authors.initials: AA
authors.lastname: Ali
authors.affiliation: Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco;
authors.forename: Khalid
authors.initials: K
authors.lastname: Sair