title: Predictive factors of mortality in Fournier's gangrene.
abstract: BACKGROUND
  Fournier's Gangrene is a rare but serious condition accounting for a high death rate. Several predictive factors of mortality have been reported from retrospective series but more often these factors vary from one study to another.
  
  
  OBJECTIVE
  The aim of this work is to assess the clinical and therapeutic characteristics of patients treated for Fournier's gangrene in order to determine the predictive factors of mortality.
  
  
  METHODS
  The study enrolled retrospectively all patients admitted in the surgery 'B' unit of Charles Nicolle hospital for Fournier's gangrene during the period ranging between January, 1st, 2000 and December, 31st, 2010. The diagnosis of Fournier's gangrene has been retained each time a tissue necrosis has been noted in perineum, whether during physical examination or intraoperatively. For all patients, clinical variables and treatments were collected. A comparative study was carried out between the group of survivors and deceased.
  
  
  RESULTS
  Forty one patients have been included. The univariate analysis identified the following predictive factors of mortality: extension of lesions outside the perineum (p=0,002), severe sepsis and/or a septic shock (p=0,006), heart rate greater than 90/min (p=0,001), white blood cell count higher than 20000/mm3 (p=0,043) and urea level higher than 7 mmol/l (p=0,009). The multivariate analysis retained the extension of gangrene beyond the perineum as an independent predictive factor of mortality (p=0,004).
  
  
  CONCLUSIONS
  Improving prognosis of Fournier's gangrene requires early diagnosis ahead of the extension of lesions beside the perineum which is associated with a higher mortality risk despite optimal care and treatment.
authors.forename: Hichem
authors.initials: H
authors.lastname: Jerraya
authors.forename: Hichem
authors.initials: H
authors.lastname: Fehri
authors.forename: Mehdi
authors.initials: M
authors.lastname: Khalfallah
authors.forename: Mohamed Morched
authors.initials: MM
authors.lastname: Abdesselem
authors.forename: Chadli
authors.initials: C
authors.lastname: Dziri