Factors for In-Hospital Mortality in 145 Male Patients with Fournier’s Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia

Abstract

Background Fournier’s gangrene (FG) is a potentially fatal necrotizing infection. Due to the rapid progression of the disease, the fatality rate remains high despite advances in therapy. This 10-year observational study from a single tertiary referral center in Indonesia aimed to identify the risk factors for in-hospital mortality from 145 male patients diagnosed with FG. Material/Methods This retrospective cohort study was conducted at one of Indonesia’s largest tertiary referral hospitals. The risk factors of in-hospital mortality were analysed using data collected through hospital medical records. All patients diagnosed with FG from January 2012 until December 2021 were included. Outcome measured was sociodemographic factors, comorbidities, laboratory findings, length of stay, culture results, and disease outcome. The microbiological culture was performed on FG lesions isolates. The statistical analysis was conducted using SPSS version 26.0. Results The analysis included 145 male patients with a median age of 52 (IQR, 43–61) years. Of them, 38 (26.20%) patients died. There were more patients with diabetes mellitus (DM) in non-survivor groups compared to survivor groups (76.3% vs 57%, p=0.035). On multivariate analysis, DM and Clostridium perfringens infection were found to be independent factors of in-hospital mortality [adjusted odds ratio (aOR)2.583, 95% confidence interval (CI)=1.061–6.289, aOR 5.982,95% CI=1.241–28.828, respectively]. Conclusions The mortality rate for FG was considerably high. DM and Clostridium perfringens infection were shown to be independent risk factors for mortality among men.

Treatment outcome of Fournier's gangrene and its associated factors: A retrospective study

“…In our study, the need for ICU admission was associated with non-survival, and our result was similar to a study by Azmi et al (8). In contrast, in the study by Yilmazlar et al, survivors stayed in the hospital significantly longer than non-survivors (24).…”

“…FG is a life-threatening condition that involves necrotizing fasciitis in the genitourinary areas and the perineum. It is typically a polymicrobial infection caused by anaerobic and facultative aerobic bacteria (8). The rapid progression of FG is linked to impaired cellular immunity, which permits suppurative bacterial infection, and the synergetic polymicrobial nature, which causes a substantial release of bacterial toxins.…”

Clostridium ramosum alone caused Fournier's gangrene in an older Chinese patient with abnormal interleukin levels: A rare case report

“…Fournier's gangrene is an extremely rare but fatal illness that affects delicate tissues of the perianal and perineal areas [ 15 ]. Many studies have shown that its overall incidence is much lower in women than in male patients [ 16 , 17 ]. Patients with Fournier's gangrene have a high mortality rate of more than 25 % [ 18 ].…”

A contemporaneous narrative review of Fournier’s gangrene

“…Azmi et al 20 noted diabetes mellitus as a comorbidity and Clostridium perfringens as the cause of FG as the independent risk factors for mortality in their study using multivariate regression analysis.…”