Fournier's gangrene: Experience with 25 patients and use of Fournier's gangrene severity index score

Objectives. To identify effective factors in the survival of patients with Fournier's gangrene and to determine the accuracy of the Fournier's gangrene severity index score. Methods. In our clinic, 25 patients with Fournier's gangrene were treated between 1995 and 2000. Data were collected about medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic therapy used. Results. The results were evaluated in two groups: those who died (n = 6) and those who survived (n = 19). No statistically significant difference was found between the age of the survivors and those who died. The admission and final laboratory parameters that correlated statistically significantly with outcome included urea, creatinine, bicarbonate, sodium, potassium, total protein, albumin, leukocyte count, hematocrit, lactate dehydrogenase, and alkaline phosphatase. The greater mean extent of body surface area involved among patients who died was significantly different statistically from that of those who survived (5.4% and 2.1%, P less than or equal to 0.0001). The mean Fournier's gangrene severity index score (FGSIS) for survivors was 3.0 +/- 1.8 compared with 12 +/- 2.4 for nonsurvivors. Regression analysis demonstrated a strong correlation between the Fournier's gangrene severity index score and the death rate (P less than or equal to 0.0001). Conclusions. Patients' metabolic status and the extent of disease at presentation is an important factor in the prognosis of Fournier's gangrene. We suggest the clinical use of FGSIS, which is simple and objective when evaluating therapeutic options and predicting outcome. (C) 2004 Elsevier Inc.