The Prognostic Factors and Validation of Severity Index in Fournier’s Gangrene

Fournier’s gangrene (FG) is a fulminant and life-threatening disease characterized by necrotizing fascitis of the perineal and genitourinary area resulting from polymicrobial infection. The polymicrobial organisms cause ascending reactions, activating various proteins and enzymes, leading to platelet aggregation, intravascular coagulation, tissue ischemic tissue change. This disease rapidly progresses, causing thrombosis and irreversible necrosis. Most of patients had predisposed or concomitant diseases such as diabetes mellitus, alcoholism, hepatic diseases, renal diseases, and cardiac diseases. It is a surgical emergency and requires prompt surgical debridement in most cases. For the treatment of Fournier’s gangrene, aggressive wide necrotic tissue debridement for survival and the proper use of antibiotics, post-operative wound management, and proper reconstruction are required. High mortality rates in Fournier’s gangrene range from 6.3 to 50%, which indicates that the variable outcome of patients with the disease is multifactorial. In general, disease related factors and host-related factors are important prognostic factors. To investigate clinical features and prognostic factors in patients who underwent the treatments of Fournier’s gangrene, Acute Physiology and Chronic Health Evaluation (APACHE) II, and the Fournier’s Gangrene Severity Index (FGSI) score which was first reported by Laor et al in 1995 were used and other scoring system. Among them, the FGSI is very useful and it can predict mortality and survival with a high probability for patients with Fournier’s gangrene according to many authors. The quantification of the extent of the disease may help determine the outcome more precisely predictions for patients with Fournier’s gangrene. We analyzed 27 patients who underwent treatments due to Fournier’s gangrene in our institution and evaluated predictive factors for mortality and survival based on pathogenesis, causative factors, and the subjects of progression. The result of this study showed that sepsis and FGSI of nine points or over at the time of hospitalization were significant risk factors for mortality.