BERKELEY, CA (UroToday Inc.) - Fournier's gangrene, despite modern intensive care techniques and medical therapy, still caries significant morbidity, and a mortality that reaches 30-50% in some series. The general rule of thumb for management is aggressive surgical debridement, but it is difficult to predict which patients will do well and which patients may need very aggressive initial management to avoid significant risk of mortality.

The Fournier's Gangrene Severity Index (FGSI) was created by modifying the acute physiology and chronic health evaluation II severity score created by Lalor in 1995. In the FGSI, nine parameters are measured, and the degree of deviation from normal is graded from 0 to 4. The individual values are summed to reach the FGSI score. These parameters are temperature, heart rate, respiratory rate, serum sodium, potassium, creatinine, and bicarbonate levels, hematocrit, and leukocyte count.

A series of 25 patients presenting with Fournier's gangrene was retrospectively reviewed for outcomes and their FGSI scores calculated to determine the accuracy of the FGSI. The report was presented by C. O. Yenizol and colleagues form Izmir, Turkey and published in the August, 2004 issue of Urology. All patients were treated in the years 1995 to 2000. Data was collected about medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic therapy used.

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 mean Fournier's Gangrene Severity Index score for survivors was 3.0 compared to 12 for non-survivors. The greater mean extent of body surface area involved among patients who died was significantly greater statistically from that of those who survived (5.4% and 2.1%). Regression analysis demonstrated a strong correlation between the FGSI score and the death rate. In addition, the duration of symptoms before presentation was statistically significant between patients who survived (1.9 days) and those who died (4.1 days). The number of surgical debridements did not seem to influence patient outcome; two to five debridements were performed for all patients. Co-morbidities such as diabetes mellitus were common among the study group. Fourteen survivors (73.6%) and 4 mortalities (66.6%) suffered from this disorder.

In conclusion, the patient's metabolic status and the extent of disease at presentation is an important factor in the prognosis of Fournier's gangrene. The Fournier's Gangrene Severity Index, which is simple to calculate, may be helpful in predicting those patients who need extra aggressive initial debridement and intensive care treatment to avoid potential mortality.

Urology. 2004 Aug; 64(2):218-22