Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases

Abstract

Introduction: 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 nonsurvivors 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). Conclusion: 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.

Overview of different scoring systems in Fournier’s Gangrene and assessment of prognostic factors

“…[7,10,25] Corcoran et al [7] found an inpatient mortality rate of 10%, with a significant difference in FGSI scores between survivors and non-survivors (5.3 in survivors vs. 10.9 in non-survivors, p=0.002). In a recent study, Tarchouli et al, [25] reported that this index was a simple, reliable and valuable method for predicting disease severity and patient survival. However, the study by Tuncel et al [11] on 20 men with FG found no association between FGSI scores and mortality.…”

Significance of Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Comparative Study

“…Experience is an additional important factor affecting mortality in the treatment of patients with Fournier's gangrene: seeing more than 1 patient per year had an adjusted 42-84% lower mortality rate (p < 0.0001) [15,16]. Another key point for improving patient outcome is the immediate start of treatment with a broad antibiotic [2,18] and intensive care therapy [18][19][20].…”

The diagnosis and management of Fournier's gangrene

“…Once considered to be the result of streptococcal infection alone, Fournier's gangrene is now understood to be polymicrobial in nature 13,14 and is typically caused by the opportunistic invasion of commensal bacteria. Commonly found organisms include Staphylococcus aureus, Streptococcus species, Escherichia coli and Acinetobacter.…”

“…Commonly found organisms include Staphylococcus aureus, Streptococcus species, Escherichia coli and Acinetobacter. 6,8,13 In this regard, antibiotic resistance may be a growing concern in Fournier's gangrene with methicillin-resistant Staphylococcus aureus (MRSA) being the most commonly cultured resistant organism. 15 Patients with multiple drug resistant organisms have shown a trend towards having poorer outcomes.…”