Is Fournier's gangrene severity index useful for predicting outcome of Fournier's gangrene?

Objectives: Fournier's gangrene (FG) is a rare but life-threatening disease. Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the mortality rate remains high. We conducted a retrospective study to analyze the outcome and identify the risk factors and prognostic indicators. Methods: We retrospectively reviewed the medical records of 25 patients diagnosed with FG between July 1993 and August 2003. Data collected included age, predisposing factors, treatment modalities, length of hospital stay, surgical debridement times, and outcome. The FG severity index was used to predict outcome. Univariate analysis of the different prognostic factors was performed using t test and Fisher's exact probability test. Results: All patients were male, 60% were diabetic, and the mean age was 55.8 years. The mean hospital stay was 20 days and the mortality rate was 32%. The mean age of 53.8 ± 18.3 (SD) years in the survival group (n = 17) was significantly lower than the 59.9 ± 10.2 years (n = 8) of the non-survival group (p < 0.05). Non-survival group patients had lower serum hematocrit (mean 28.9, p = 0.019) and albumin (mean 1.93, p = 0.024) levels. In our series, the mean FG severity index for survivors was 4.41 ± 2.45 (range 2-9) compared to 12.75 ± 2.82 (range 9-18) for those who died (t test, p < 0.0001). Conclusion: The survival rate of younger patients with FG was higher. We agree that a FG severity index cutoff value of 9 is an excellent predictor of outcome.