Predictive factors for mortality in Fournier' gangrene: A serie of 59 cases - Abstract

AIMS: Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate.

The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department.

METHODS: Retrospective analysis study between 1998 and 2012.

RESULTS: Of the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; P=.023), hemoglobin (S 13; D 11; P=.014), hematocrit (S 37; D 31.4; P=.009), white blood cells (S 17,400; D 23,800; P=.023), serum urea (S 58; D 102; P< .001), creatinine (S 1.1; D 1.9; P=.032), potassium (S 3.7; D 4.4; P=.012) and alkaline phosphatase (S 92; D 133; P=.014). Predictive scores: Charlson index (S 1; D 4; P=.013), severe sepsis criteria (S 16 [36%]; D 13 [86%]; P=.001), Fournier's gangrene severity index score (FGSIS) (S 4; D 7; P=.002) and Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; D 13; P=.004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760-0.973), higher than FGSIS (0.746 [0.601-0.981]) and UFGSI (0.760 [0.617-0.904]).

CONCLUSIONS: FG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described.

Written by:
García Marín A, Turégano Fuentes F, Cuadrado Ayuso M, Andueza Lillo JA, Cano Ballesteros JC, Pérez López M.   Are you the author?
Servicio de Cirugía de Urgencias, Hospital Universitario San Juan, Alicante, España; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, España; Sección Cirugía de Urgencias, Servicio de Cirugía General 2, Hospital General Universitario Gregorio Marañón, Madrid, España; Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Enfermería, Universidad de Alicante, Alicante, España.  

Reference: Cir Esp. 2014 May 23. pii: S0009-739X(14)00156-0.
doi: 10.1016/j.ciresp.2014.03.017

PubMed Abstract
PMID: 24862684

Article in English, Spanish. Infections Section