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

Abstract

Objective: In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier's gangrene (FG), and overview different validated scoring systems for outcome prediction. Material and methods:We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis.Results: Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0-9) for the survivors and 6 (2-14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0-10) and 6.5 (5-11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. Conclusion:High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.

Incorporating Simplified Fournier's Gangrene Severity Index with early surgical intervention can maximize survival in high‐risk Fournier's gangrene patients

“…Doluoglu et al . showed that the median FGSI scores were significantly higher in non‐survivors than survivors . UFGSI and ACCI comprise 11 and 20 parameters, respectively .…”

“…Doluoglu et al showed that the median FGSI scores were significantly higher in non-survivors than survivors. 28 UFGSI and ACCI comprise 11 and 20 parameters, respectively. 21,22 FGSI, UFGSI and ACCI are sophisticated scoring systems, but cannot be efficiently applied in clinical practice.…”

Fournier’s Gangrene: Literature Review and Clinical Cases

“…Doluoğlu et al [13] in the study of the outcomes of 39 patients with Fournier gangrene found that an unfavorable prognosis was significantly more frequent in patients with elevated urea levels, low albumin, and hematocrit. Sen et al [14] indicate the need to determine glycated hemoglobin in order to predict the outcome of the disease, since patients with a high level of this indicator in the study had a significantly more often adverse outcome.…”

Desperate need for better management of Fournier's Gangrene

“…Furthermore, our study population revealed no significant risk factors for death or multi-resistant pathogens, however, we assume that no one used a prognostic scoring system for FG like the Fournier's gangrene severity index (FGSI), Laboratory Risk Indicator for necrotizing fasciitis (LRINEC) or neutrophil lymphocyte ratio (NLR) in our study centres [ 6 ]. All of the prognostic scoring systems for FG are controversial [ 4 , 6 , 8 , 9 , 13 ]. The main problem is that these prognostic factors and scoring systems are all based on retrospective data – thus the scoring systems in particular require prospective analysis to determine their efficacy in daily clinical practice.…”